wendynovakdiabetesinstitute.com
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URL:
https://wendynovakdiabetesinstitute.com/
Submission Tags: phishingrod
Submission: On January 22 via api from DE — Scanned from DE
Submission Tags: phishingrod
Submission: On January 22 via api from DE — Scanned from DE
Form analysis 2 forms found in the DOM
Name: subscribeForm — POST https://nortonhealthcare.com/get-healthy-email
<form id="subscribeForm" action="https://nortonhealthcare.com/get-healthy-email" method="post" name="subscribeForm" target="_parent" class="form form-newsletter" _lpchecked="1">
<input name="thx" type="hidden" value="https://nortonhealthcare.com/subscribe/success/">
<input name="err" type="hidden" value="https://nortonhealthcare.com/subscribe/error/">
<input name="SubAction" type="hidden" value="sub_add_update">
<input name="MID" type="hidden" value="7233914">
<div class="input-group mt-3">
<!-- <label class="control-label" for="email">Email</label> -->
<input id="email" class="form-control" name="Email Address" required="" type="email" placeholder="Your Email..." data-error="Email address is invalid">
<button class="btn btn-warning" type="submit" value="Submit">
<svg class="svg-inline--fa fa-envelope fa-w-16 fa-2x text-white" aria-hidden="true" focusable="false" data-prefix="fal" data-icon="envelope" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" data-fa-i2svg="">
<path fill="currentColor"
d="M464 64H48C21.5 64 0 85.5 0 112v288c0 26.5 21.5 48 48 48h416c26.5 0 48-21.5 48-48V112c0-26.5-21.5-48-48-48zM48 96h416c8.8 0 16 7.2 16 16v41.4c-21.9 18.5-53.2 44-150.6 121.3-16.9 13.4-50.2 45.7-73.4 45.3-23.2.4-56.6-31.9-73.4-45.3C85.2 197.4 53.9 171.9 32 153.4V112c0-8.8 7.2-16 16-16zm416 320H48c-8.8 0-16-7.2-16-16V195c22.8 18.7 58.8 47.6 130.7 104.7 20.5 16.4 56.7 52.5 93.3 52.3 36.4.3 72.3-35.5 93.3-52.3 71.9-57.1 107.9-86 130.7-104.7v205c0 8.8-7.2 16-16 16z">
</path>
</svg><!-- <i class="fal fa-envelope fa-2x text-white"></i> Font Awesome fontawesome.com -->
</button>
</div>
</form><form id="mongo-form">
<div id="bboxdonation_BBEmbeddedForm" class="BBFormContainer BBFormWidthNarrow-Less600 BBFormWidthNarrow-Less500 BBFormWidthNarrow-Less400" data-bbox-part-id="4b5dc007-22ad-4074-8bd5-58c6a61fa9bc">
<div id="bboxdonation_divForm">
<div id="divClientError" class="BBFormErrorBlock" style="display: none"></div>
<div class="BBFormSection BBDFormSectionGiftInfo">
<fieldset>
<legend>
<div class="BBFormSectionHeading">
<label id="bboxdonation_gift_lblHeadingDonation" class="BBFormFieldLabelEdit">Donation</label>
</div>
</legend>
<div id="bboxdonation_gift_fldAmountWithLevels" class="BBFormFieldContainer BBFormFieldContainerGivingLevels BBFormErrorNoMargin" data-style="Narrow_Buttons">
<span id="bboxdonation_gift_lblGivingLevels" class="BBFormFieldLabelGivingLevel BBFormFieldLabel BBFormFieldLabelEdit" style="display:none;">Gift amount:</span>
<div id="bboxdonation_gift_rdlstGivingLevels" class="BBFormRadioList">
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="50" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel1" checked="checked"
class="BBFormRadioButton BBFormRadioGivingLevel BBFormRadioGivingLevelSelected"><label for="bboxdonation_gift_rdGivingLevel1" class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelSelected"><span
class="BBFormRadioAmount">$50</span></label></div>
</div>
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="100" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel2" class="BBFormRadioButton BBFormRadioGivingLevel"><label
for="bboxdonation_gift_rdGivingLevel2" class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelNotSelected"><span class="BBFormRadioAmount">$100</span></label></div>
</div>
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="500" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel3" class="BBFormRadioButton BBFormRadioGivingLevel"><label
for="bboxdonation_gift_rdGivingLevel3" class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelNotSelected"><span class="BBFormRadioAmount">$500</span></label></div>
</div>
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="1000" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel4" class="BBFormRadioButton BBFormRadioGivingLevel"><label
for="bboxdonation_gift_rdGivingLevel4" class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelNotSelected"><span class="BBFormRadioAmount">$1,000</span></label></div>
</div>
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="rdGivingLevel5" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel5" data-min-payment="1" title="Other gift amount"
class="BBFormRadioButton BBFormRadioGivingLevel BBFormRadioGivingLevelOther"><label for="bboxdonation_gift_rdGivingLevel5" title="Other gift amount" aria-labelledby="bboxdonation_gift_rdGivingLevel5"
class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelNotSelected BBFormRadioLabelGivingLevelOther"><span class="BBFormRadioDescriptionOther">Other</span><input
name="bboxdonation$gift$txtOtherAmountButtons" type="text" id="bboxdonation_gift_txtOtherAmountButtons" class="BBFormTextbox BBFormGiftOtherAmount BBFormCurrency" placeholder="$" data-culture="en-US"
aria-labelledby="bboxdonation_gift_rdGivingLevel5" title="Other gift amount"></label></div>
</div>
</div>
<div class="BBClearFix">
</div>
</div>
<div id="bboxdonation_gift_fldPledgeAmountWhenNoLevels" class="BBFormFieldContainer BBFormNoLevels BBFormPledgeFields" style="display: none;">
<label for="bboxdonation_gift_txtAmountPledge" id="bboxdonation_gift_lblAmountPledge" class="BBFormFieldLabel BBFormFieldLabelAmount BBFormFieldLabelEdit">Amount:</label>
<input name="bboxdonation$gift$txtAmountPledge" type="text" id="bboxdonation_gift_txtAmountPledge" class="BBFormTextbox BBFormCurrency" required="required" placeholder="$" data-culture="en-US" data-min-payment="10.0000">
</div>
</fieldset>
</div>
<input name="bboxdonation$gift$hdnGivingLevelButtonsEnabled" type="hidden" id="bboxdonation_gift_hdnGivingLevelButtonsEnabled" class="hdnGivingLevelButtonsEnabled" value="true">
<input name="bboxdonation$gift$hdnPledgeDuration" type="hidden" id="bboxdonation_gift_hdnPledgeDuration" class="hdnPledgeDuration">
<input name="bboxdonation$gift$hdnPledgePayment" type="hidden" id="bboxdonation_gift_hdnPledgePayment" class="hdnPledgePayment">
<input name="bboxdonation$gift$hdnGiftButtonsStyle" type="hidden" id="bboxdonation_gift_hdnGiftButtonsStyle" class="hdnGiftButtonsStyle">
<div class="BBFormSection BBFormSectionRecurrenceInfo">
<fieldset>
<legend>
<div id="bboxdonation_recurrence_divHeadingRecurrence" class="BBFormSectionHeading">
<label id="bboxdonation_recurrence_lblHeadingRecurrence" class="BBFormFieldLabelEdit">Recurring Gift</label>
</div>
</legend>
<div class="BBFormFieldContainer">
<div id="bboxdonation_recurrence_divRecurrenceCheckbox">
<input name="bboxdonation$recurrence$chkMonthlyGift" type="checkbox" id="bboxdonation_recurrence_chkMonthlyGift">
<label for="bboxdonation_recurrence_chkMonthlyGift" id="bboxdonation_recurrence_lblRecurringGift" class="BBFormFieldLabel BBFormCheckbox BBFormCheckboxLabel">Make this a monthly gift</label>
</div>
<div class="BBFloatClear"></div>
<div class="BBFormFieldRecurrenceInfo" style="display: none;">
<div id="bboxdonation_recurrence_divRecurrenceInfo">
<div class="BBRecurrenceFieldContainer" style="font-style: normal;">
<span>Give <select name="bboxdonation$recurrence$ddFrequency" id="bboxdonation_recurrence_ddFrequency" class="BBFormSelectList">
<option value="2" optionid="d82e912e-38d0-4ea5-a32b-fc5393abac3c">monthly</option>
</select> on <select name="bboxdonation$recurrence$ddFrequencyDate" id="bboxdonation_recurrence_ddFrequencyDate" class="BBFormSelectList" aria-label="frequency">
<option value="5" data-nextpayment="05.02.2024">day 5 of each month</option>
<option value="15" data-nextpayment="15.02.2024">day 15 of each month</option>
<option value="30" data-nextpayment="30.01.2024">day 30 of each month</option>
</select></span>
</div>
<div>
<span id="lblRecurrenceNextGiftDate">Your first gift will occur on 5/2/2024</span>
</div>
</div>
</div>
</div>
</fieldset>
<input name="bboxdonation$recurrence$hdnRecurringOnly" type="hidden" id="bboxdonation_recurrence_hdnRecurringOnly">
<input name="bboxdonation$recurrence$hdnDateOptions" type="hidden" id="bboxdonation_recurrence_hdnDateOptions"
value="[{"frequency":2,"values":"5;15;30","paymentDates":"05.02.2024;15.02.2024;30.01.2024"}]">
<input name="bboxdonation$recurrence$hdnRecurringOptionValue" type="hidden" id="bboxdonation_recurrence_hdnRecurringOptionValue" value="5">
</div>
<div class="BBFormSection BBDFormSectionTributeInfo BBFormAddressBlock">
<fieldset>
<legend>
<div class="BBFormSectionHeading">
<label id="bboxdonation_tribute_lblHeadingTribute" class="BBFormFieldLabelEdit">Tribute Gift</label>
</div>
</legend>
<div id="bboxdonation_tribute_divTributeGeneral">
<div class="BBFormFieldContainer">
<input name="bboxdonation$tribute$chkTributeGift" type="checkbox" id="bboxdonation_tribute_chkTributeGift">
<label for="bboxdonation_tribute_chkTributeGift" id="bboxdonation_tribute_lblTributeGift" class="BBFormFieldLabel BBFormCheckbox BBFormCheckboxLabel BBFormFieldLabelEdit">This gift is in honor, memory, or support of someone</label>
</div>
<div id="divGeneralTributeInfo" style="display: none;">
<div class="BBFormFieldContainer BBFormFieldTributeInfo">
<span id="bboxdonation_tribute_lblGeneralTributeInfo" class="BBFormFieldLabel BBFormFieldLabelEdit">This gift is</span>
<select name="bboxdonation$tribute$ddTributeTypes" id="bboxdonation_tribute_ddTributeTypes" class="BBFormSelectList">
<option value="387">In Honor of</option>
<option value="388">In Memory of</option>
</select>
</div>
<div class="BBFormFieldContainer BBFormFieldTributeInfo">
<label for="bboxdonation_tribute_txtTributeRecordName" id="bboxdonation_tribute_lblTributeRecordName" class="BBFormFieldLabel BBAccessibilityOnly">Tribute honoree name:</label>
<input name="bboxdonation$tribute$txtTributeRecordName" type="text" id="bboxdonation_tribute_txtTributeRecordName" class="BBFormTextbox" required="required" placeholder="full name" maxlength="150">
</div>
</div>
</div>
<div id="divTributeAcknowledge" class="BBFormTributeAcknowledgeContainer" style="display: none;">
<div class="BBFormFieldContainer">
<input name="bboxdonation$tribute$hdnAllowTributeNotification" type="hidden" id="bboxdonation_tribute_hdnAllowTributeNotification" value="1">
<input name="bboxdonation$tribute$chkTributeAcknowledgee" type="checkbox" id="bboxdonation_tribute_chkTributeAcknowledgee">
<label for="bboxdonation_tribute_chkTributeAcknowledgee" id="bboxdonation_tribute_lblTributeAcknowledgee" class="BBFormFieldLabel BBFormCheckbox BBFormCheckboxLabel BBFormFieldLabelEdit">Please notify the following person of my
gift</label>
</div>
<div id="divTributeAcknowledgeeInfo" class="BBFormTributeAcknowledgeeContainer" style="display: none;">
<div class="BBFormIndivFields">
<div class="BBFormFieldContainer BBFormFieldContainerRequired BBTwoFields">
<label for="bboxdonation_tribute_txtFirstName" id="bboxdonation_tribute_lblName" class="BBFormFieldLabel BBFormFieldLabelEdit ">Name:</label>
<div aria-describedby="bboxdonation_tribute_txtFirstName">
<span id="bboxdonation_tribute_lblFirstName" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly ">First name:</span>
</div>
<input name="bboxdonation$tribute$txtFirstName" type="text" id="bboxdonation_tribute_txtFirstName" class="BBFormTextbox" required="required" maxlength="50" placeholder="first name">
<label for="bboxdonation_tribute_txtLastName" id="bboxdonation_tribute_lblLastName" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Last name:</label>
<input name="bboxdonation$tribute$txtLastName" type="text" id="bboxdonation_tribute_txtLastName" class="BBFormTextbox" required="required" maxlength="100" placeholder="last name">
</div>
</div>
<div class="BBFormFieldTributeAcknowledgee BBFormAddressBlock">
<div class="BBFormAddress">
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="bboxdonation_tribute_tributeAddress_ddCountry" id="bboxdonation_tribute_tributeAddress_lblCountry" class="BBFormFieldLabel BBFormFieldLabelEdit">Country:</label>
<select name="bboxdonation$tribute$tributeAddress$ddCountry" id="bboxdonation_tribute_tributeAddress_ddCountry" class="BBFormSelectList BBFormCountryDropDown" required="required">
<option selected="selected" value="United States" data-country-format="1" data-short-text="US">United States</option>
<option value="Canada" data-country-format="3" data-short-text="CA">Canada</option>
<option value="United Kingdom" data-country-format="2" data-short-text="GB">United Kingdom</option>
<option value="Australia" data-country-format="4" data-short-text="AU">Australia</option>
<option value="New Zealand" data-country-format="5" data-short-text="NZ">New Zealand</option>
</select>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="bboxdonation_tribute_tributeAddress_txtAddress" id="bboxdonation_tribute_tributeAddress_lblAddress" class="BBFormFieldLabel BBFormFieldLabelEdit">Address:</label>
<textarea name="bboxdonation$tribute$tributeAddress$txtAddress" id="bboxdonation_tribute_tributeAddress_txtAddress" class="BBFormTextArea" rows="2" cols="30" required="required" data-country-field="address"
maxlength="150"></textarea>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="1">
<label for="bboxdonation_tribute_tributeAddress_txtCity" id="bboxdonation_tribute_tributeAddress_lblCity" class="BBFormFieldLabel BBFormFieldLabelEdit">City:</label>
<input name="bboxdonation$tribute$tributeAddress$txtCity" type="text" id="bboxdonation_tribute_tributeAddress_txtCity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50">
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="1">
<label for="bboxdonation_tribute_tributeAddress_ddState" id="bboxdonation_tribute_tributeAddress_lblStateZip" class="BBFormFieldLabel BBFormFieldLabelEdit">State & zip:</label>
<div aria-describedby="bboxdonation_tribute_tributeAddress_ddState">
<span id="bboxdonation_tribute_tributeAddress_lblState" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">State:</span>
</div>
<select name="bboxdonation$tribute$tributeAddress$ddState" id="bboxdonation_tribute_tributeAddress_ddState" class="BBFormSelectList GhostText" data-country-sync="1" data-country-field="state" required="required">
<option selected="selected" value="" default="default">state</option>
<option value="Non">Non</option>
<option value="AA">AA</option>
<option value="AB">AB</option>
<option value="AE">AE</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AP">AP</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="BC">BC</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="CZ">CZ</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MB">MB</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NB">NB</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NL">NL</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NS">NS</option>
<option value="NT">NT</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="ON">ON</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PE">PE</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="QC">QC</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="SK">SK</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="YT">YT</option>
<option value="NU">NU</option>
<option value="VIC">VIC</option>
</select>
<label for="bboxdonation_tribute_tributeAddress_txtZip" id="bboxdonation_tribute_tributeAddress_lblZip" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Zip:</label>
<input name="bboxdonation$tribute$tributeAddress$txtZip" type="tel" id="bboxdonation_tribute_tributeAddress_txtZip" class="BBFormTextbox" data-country-field="postcode" data-country-sync="1" required="required" maxlength="12"
placeholder="zip">
</div>
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="2" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_txtUKCity" id="bboxdonation_tribute_tributeAddress_lblUKCityCounty" class="BBFormFieldLabel BBFormFieldLabelEdit">City & county:</label>
<div aria-describedby="bboxdonation_tribute_tributeAddress_txtUKCity">
<span id="bboxdonation_tribute_tributeAddress_lblUKCity" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">City:</span>
</div>
<input name="bboxdonation$tribute$tributeAddress$txtUKCity" type="text" id="bboxdonation_tribute_tributeAddress_txtUKCity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50"
placeholder="city">
<label for="bboxdonation_tribute_tributeAddress_ddUKCounty" id="bboxdonation_tribute_tributeAddress_lblUKCounty" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">County:</label>
<select name="bboxdonation$tribute$tributeAddress$ddUKCounty" id="bboxdonation_tribute_tributeAddress_ddUKCounty" class="BBFormSelectList GhostText" data-country-field="county">
<option selected="selected" value="" default="default">county (optional)</option>
<option value="Alamosa">Alamosa</option>
<option value="Angelina">Angelina</option>
<option value="Calaveras">Calaveras</option>
<option value="Cleburne">Cleburne</option>
<option value="Del Norte">Del Norte</option>
<option value="Dunklin">Dunklin</option>
<option value="Kittitas">Kittitas</option>
<option value="McPherson">McPherson</option>
<option value="Montezuma">Montezuma</option>
<option value="Sutter">Sutter</option>
<option value="97086">97086</option>
<option value="Ada">Ada</option>
<option value="Adair">Adair</option>
<option value="Adams">Adams</option>
<option value="Aiken">Aiken</option>
<option value="Alachua">Alachua</option>
<option value="Alamance">Alamance</option>
<option value="Alameda">Alameda</option>
<option value="Albany">Albany</option>
<option value="Albemarle">Albemarle</option>
<option value="Alcorn">Alcorn</option>
<option value="Alexander">Alexander</option>
<option value="Alexandria City">Alexandria City</option>
<option value="Alfalfa">Alfalfa</option>
<option value="Alger">Alger</option>
<option value="Allegan">Allegan</option>
<option value="Allegany">Allegany</option>
<option value="Alleghany">Alleghany</option>
<option value="Allegheny">Allegheny</option>
<option value="Allen">Allen</option>
<option value="Alpena">Alpena</option>
<option value="Amherst">Amherst</option>
<option value="Anchorage">Anchorage</option>
<option value="Anderson">Anderson</option>
<option value="Androscoggin">Androscoggin</option>
<option value="Anne Arundel">Anne Arundel</option>
<option value="Anoka">Anoka</option>
<option value="Antrim">Antrim</option>
<option value="Appanoose">Appanoose</option>
<option value="Appomattox">Appomattox</option>
<option value="Aransas">Aransas</option>
<option value="Arapahoe">Arapahoe</option>
<option value="Archuleta">Archuleta</option>
<option value="Arenac">Arenac</option>
<option value="Arlington">Arlington</option>
<option value="Armstrong">Armstrong</option>
<option value="Aroostook">Aroostook</option>
<option value="Ascension">Ascension</option>
<option value="Ashe">Ashe</option>
<option value="Ashland">Ashland</option>
<option value="Ashtabula">Ashtabula</option>
<option value="Atchison">Atchison</option>
<option value="Athens">Athens</option>
<option value="Atkinson">Atkinson</option>
<option value="Atlantic">Atlantic</option>
<option value="Auglaize">Auglaize</option>
<option value="Austin">Austin</option>
<option value="Autauga">Autauga</option>
<option value="Avery">Avery</option>
<option value="Avoyelles">Avoyelles</option>
<option value="Bailey">Bailey</option>
<option value="Baker">Baker</option>
<option value="Baldwin">Baldwin</option>
<option value="Ballard">Ballard</option>
<option value="Baltimore">Baltimore</option>
<option value="Baltimore City">Baltimore City</option>
<option value="Bandera">Bandera</option>
<option value="Bannock">Bannock</option>
<option value="Barbour">Barbour</option>
<option value="Barnstable">Barnstable</option>
<option value="Barnwell">Barnwell</option>
<option value="Barren">Barren</option>
<option value="Barrow">Barrow</option>
<option value="Barry">Barry</option>
<option value="Bartholomew">Bartholomew</option>
<option value="Bartow">Bartow</option>
<option value="Bastrop">Bastrop</option>
<option value="Bath">Bath</option>
<option value="Baxter">Baxter</option>
<option value="Bay">Bay</option>
<option value="Beaufort">Beaufort</option>
<option value="Beauregard">Beauregard</option>
<option value="Beaver">Beaver</option>
<option value="Becker">Becker</option>
<option value="Beckham">Beckham</option>
<option value="Bedford">Bedford</option>
<option value="Bee">Bee</option>
<option value="Belknap">Belknap</option>
<option value="Bell">Bell</option>
<option value="Belmont">Belmont</option>
<option value="Bennington">Bennington</option>
<option value="Benton">Benton</option>
<option value="Benzie">Benzie</option>
<option value="Bergen">Bergen</option>
<option value="Berkeley">Berkeley</option>
<option value="Berks">Berks</option>
<option value="Berkshire">Berkshire</option>
<option value="Bernalillo">Bernalillo</option>
<option value="Berrien">Berrien</option>
<option value="Bexar">Bexar</option>
<option value="Bibb">Bibb</option>
<option value="Big Horn">Big Horn</option>
<option value="Black Hawk">Black Hawk</option>
<option value="Blackford">Blackford</option>
<option value="Blaine">Blaine</option>
<option value="Blair">Blair</option>
<option value="Bleckley">Bleckley</option>
<option value="Bledsoe">Bledsoe</option>
<option value="Blount">Blount</option>
<option value="Bollinger">Bollinger</option>
<option value="Bond">Bond</option>
<option value="Bonner">Bonner</option>
<option value="Bonneville">Bonneville</option>
<option value="Boone">Boone</option>
<option value="Bossier">Bossier</option>
<option value="Botetourt">Botetourt</option>
<option value="Boulder">Boulder</option>
<option value="Bourbon">Bourbon</option>
<option value="Bowie">Bowie</option>
<option value="Boyce">Boyce</option>
<option value="Boyd">Boyd</option>
<option value="Boyle">Boyle</option>
<option value="Bracken">Bracken</option>
<option value="Bradford">Bradford</option>
<option value="Bradley">Bradley</option>
<option value="Branch">Branch</option>
<option value="Braxton">Braxton</option>
<option value="Brazoria">Brazoria</option>
<option value="Brazos">Brazos</option>
<option value="Breathitt">Breathitt</option>
<option value="Breckenridge">Breckenridge</option>
<option value="Breckinridge">Breckinridge</option>
<option value="Bremer">Bremer</option>
<option value="Brevard">Brevard</option>
<option value="Brewster">Brewster</option>
<option value="Bristol">Bristol</option>
<option value="Bristol City">Bristol City</option>
<option value="Bronx">Bronx</option>
<option value="Brooks">Brooks</option>
<option value="Broome">Broome</option>
<option value="Broomfield">Broomfield</option>
<option value="Broward">Broward</option>
<option value="Brown">Brown</option>
<option value="Brunswick">Brunswick</option>
<option value="Bryan">Bryan</option>
<option value="Buchanan">Buchanan</option>
<option value="Bucks">Bucks</option>
<option value="Buena Vista">Buena Vista</option>
<option value="Buena Vista City">Buena Vista City</option>
<option value="Buffalo">Buffalo</option>
<option value="Bullitt">Bullitt</option>
<option value="Bulloch">Bulloch</option>
<option value="Buncombe">Buncombe</option>
<option value="Bureau">Bureau</option>
<option value="Burke">Burke</option>
<option value="Burleigh">Burleigh</option>
<option value="Burleson">Burleson</option>
<option value="Burlington">Burlington</option>
<option value="Burnet">Burnet</option>
<option value="Burnett">Burnett</option>
<option value="Butler">Butler</option>
<option value="Butte">Butte</option>
<option value="Butts">Butts</option>
<option value="Cabarrus">Cabarrus</option>
<option value="Cabell">Cabell</option>
<option value="Cache">Cache</option>
<option value="Caddo">Caddo</option>
<option value="Calcasieu">Calcasieu</option>
<option value="Caldwell">Caldwell</option>
<option value="Caledonia">Caledonia</option>
<option value="Calhoun">Calhoun</option>
<option value="Callahan">Callahan</option>
<option value="Callaway">Callaway</option>
<option value="Calloway">Calloway</option>
<option value="Calvert">Calvert</option>
<option value="Cambria">Cambria</option>
<option value="Camden">Camden</option>
<option value="Cameron">Cameron</option>
<option value="Campbell">Campbell</option>
<option value="Canadian">Canadian</option>
<option value="Cannon">Cannon</option>
<option value="Canyon">Canyon</option>
<option value="Cape Girardeau">Cape Girardeau</option>
<option value="Cape May">Cape May</option>
<option value="Carbon">Carbon</option>
<option value="Caribou">Caribou</option>
<option value="Carlisle">Carlisle</option>
<option value="Carlton">Carlton</option>
<option value="Caroline">Caroline</option>
<option value="Carroll">Carroll</option>
<option value="Carrollton">Carrollton</option>
<option value="Carson City">Carson City</option>
<option value="Carter">Carter</option>
<option value="Carteret">Carteret</option>
<option value="Carver">Carver</option>
<option value="Cascade">Cascade</option>
<option value="Casey">Casey</option>
<option value="Cass">Cass</option>
<option value="Catawba">Catawba</option>
<option value="Catoosa">Catoosa</option>
<option value="Cattaraugus">Cattaraugus</option>
<option value="Cayuga">Cayuga</option>
<option value="Cecil">Cecil</option>
<option value="Cedar">Cedar</option>
<option value="Centre">Centre</option>
<option value="Cerro Gordo">Cerro Gordo</option>
<option value="Chambers">Chambers</option>
<option value="Champaign">Champaign</option>
<option value="Chariton">Chariton</option>
<option value="Charles">Charles</option>
<option value="Charleston">Charleston</option>
<option value="Charlevoix">Charlevoix</option>
<option value="Charlotte">Charlotte</option>
<option value="Charlottesville City">Charlottesville City</option>
<option value="Chase">Chase</option>
<option value="Chatham">Chatham</option>
<option value="Chattahoochee">Chattahoochee</option>
<option value="Chattooga">Chattooga</option>
<option value="Chautauqua">Chautauqua</option>
<option value="Chaves">Chaves</option>
<option value="Cheatham">Cheatham</option>
<option value="Cheboygan">Cheboygan</option>
<option value="Chelan">Chelan</option>
<option value="Chemung">Chemung</option>
<option value="Chenango">Chenango</option>
<option value="Cherokee">Cherokee</option>
<option value="Cherry">Cherry</option>
<option value="Chesapeake City">Chesapeake City</option>
<option value="Cheshire">Cheshire</option>
<option value="Chester">Chester</option>
<option value="Chesterfield">Chesterfield</option>
<option value="Cheyenne">Cheyenne</option>
<option value="Chickasaw">Chickasaw</option>
<option value="Childress">Childress</option>
<option value="Chilton">Chilton</option>
<option value="Chippewa">Chippewa</option>
<option value="Chisago">Chisago</option>
<option value="Chittenden">Chittenden</option>
<option value="Chowan">Chowan</option>
<option value="Christian">Christian</option>
<option value="Churchill">Churchill</option>
<option value="Citrus">Citrus</option>
<option value="Clackamas">Clackamas</option>
<option value="Cladwell">Cladwell</option>
<option value="Claek">Claek</option>
<option value="Claiborne">Claiborne</option>
<option value="Clallam">Clallam</option>
<option value="Clare">Clare</option>
<option value="Clarendon">Clarendon</option>
<option value="Clark">Clark</option>
<option value="Clarke">Clarke</option>
<option value="Clarl">Clarl</option>
<option value="Clatsop">Clatsop</option>
<option value="Clay">Clay</option>
<option value="Clayton">Clayton</option>
<option value="Clear Creek">Clear Creek</option>
<option value="Clermont">Clermont</option>
<option value="Cleveland">Cleveland</option>
<option value="Clinton">Clinton</option>
<option value="Cobb">Cobb</option>
<option value="Cochise">Cochise</option>
<option value="Cocke">Cocke</option>
<option value="Coconino">Coconino</option>
<option value="Coffee">Coffee</option>
<option value="Colbert">Colbert</option>
<option value="Cole">Cole</option>
<option value="Coleman">Coleman</option>
<option value="Coles">Coles</option>
<option value="Colfax">Colfax</option>
<option value="Colleton">Colleton</option>
<option value="Collier">Collier</option>
<option value="Collin">Collin</option>
<option value="Colonial Heights City">Colonial Heights City</option>
<option value="Colorado">Colorado</option>
<option value="Colquitt">Colquitt</option>
<option value="Columbia">Columbia</option>
<option value="Columbiana">Columbiana</option>
<option value="Columbus">Columbus</option>
<option value="Colusa">Colusa</option>
<option value="Comal">Comal</option>
<option value="Comanche">Comanche</option>
<option value="Contra Costa">Contra Costa</option>
<option value="Converse">Converse</option>
<option value="Conway">Conway</option>
<option value="Cook">Cook</option>
<option value="Cooper">Cooper</option>
<option value="Coos">Coos</option>
<option value="Cortland">Cortland</option>
<option value="Coryell">Coryell</option>
<option value="Coshocton">Coshocton</option>
<option value="Covington">Covington</option>
<option value="Coweta">Coweta</option>
<option value="Cowley">Cowley</option>
<option value="Cowlitz">Cowlitz</option>
<option value="Craig">Craig</option>
<option value="Craighead">Craighead</option>
<option value="Craven">Craven</option>
<option value="Crawford">Crawford</option>
<option value="Creek">Creek</option>
<option value="Crestwood">Crestwood</option>
<option value="Crittenden">Crittenden</option>
<option value="Crittendon">Crittendon</option>
<option value="Cross">Cross</option>
<option value="Crow Wing">Crow Wing</option>
<option value="Cullman">Cullman</option>
<option value="Culpeper">Culpeper</option>
<option value="Cumberland">Cumberland</option>
<option value="Curry">Curry</option>
<option value="Custer">Custer</option>
<option value="Cuyahoga">Cuyahoga</option>
<option value="Dade">Dade</option>
<option value="Dakota">Dakota</option>
<option value="Dale">Dale</option>
<option value="Dallas">Dallas</option>
<option value="Dane">Dane</option>
<option value="Danville City">Danville City</option>
<option value="Dare">Dare</option>
<option value="Darke">Darke</option>
<option value="Darlington">Darlington</option>
<option value="Dauphin">Dauphin</option>
<option value="Davidson">Davidson</option>
<option value="Davie">Davie</option>
<option value="Daviess">Daviess</option>
<option value="Davis">Davis</option>
<option value="Davison">Davison</option>
<option value="Dawes">Dawes</option>
<option value="Dawson">Dawson</option>
<option value="De Kalb">De Kalb</option>
<option value="De Soto">De Soto</option>
<option value="Dearborn">Dearborn</option>
<option value="Decatur">Decatur</option>
<option value="Defiance">Defiance</option>
<option value="Dekalb">Dekalb</option>
<option value="Delaware">Delaware</option>
<option value="Delta">Delta</option>
<option value="Dent">Dent</option>
<option value="Denton">Denton</option>
<option value="Denver">Denver</option>
<option value="Des Moines">Des Moines</option>
<option value="Deschutes">Deschutes</option>
<option value="DeSoto">DeSoto</option>
<option value="Deuel">Deuel</option>
<option value="Dewitt">Dewitt</option>
<option value="Dickinson">Dickinson</option>
<option value="Dickson">Dickson</option>
<option value="Dillon">Dillon</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Dodge">Dodge</option>
<option value="Dolores">Dolores</option>
<option value="Dona Ana">Dona Ana</option>
<option value="Door">Door</option>
<option value="Dorchester">Dorchester</option>
<option value="Dougherty">Dougherty</option>
<option value="Douglas">Douglas</option>
<option value="Drew">Drew</option>
<option value="Dubois">Dubois</option>
<option value="Dubuque">Dubuque</option>
<option value="Dukes">Dukes</option>
<option value="Dunn">Dunn</option>
<option value="Dupage">Dupage</option>
<option value="Duplin">Duplin</option>
<option value="Durham">Durham</option>
<option value="Dutchess">Dutchess</option>
<option value="Duval">Duval</option>
<option value="Dyer">Dyer</option>
<option value="Eagle">Eagle</option>
<option value="Early">Early</option>
<option value="East Baton Rouge">East Baton Rouge</option>
<option value="Eaton">Eaton</option>
<option value="Eau Claire">Eau Claire</option>
<option value="Ector">Ector</option>
<option value="Edgar">Edgar</option>
<option value="Edgecombe">Edgecombe</option>
<option value="Edgefield">Edgefield</option>
<option value="Edmondson">Edmondson</option>
<option value="Edmonson">Edmonson</option>
<option value="Edmonton">Edmonton</option>
<option value="Edwards">Edwards</option>
<option value="Effingham">Effingham</option>
<option value="El Dorado">El Dorado</option>
<option value="El Paso">El Paso</option>
<option value="Elbert">Elbert</option>
<option value="Elkhart">Elkhart</option>
<option value="Elliott">Elliott</option>
<option value="Ellis">Ellis</option>
<option value="Elmore">Elmore</option>
<option value="Emanuel">Emanuel</option>
<option value="Emmet">Emmet</option>
<option value="Erie">Erie</option>
<option value="Escambia">Escambia</option>
<option value="Essex">Essex</option>
<option value="Estill">Estill</option>
<option value="Etowah">Etowah</option>
<option value="Evans">Evans</option>
<option value="Fairbanks North Star">Fairbanks North Star</option>
<option value="Fairfax">Fairfax</option>
<option value="Fairfax City">Fairfax City</option>
<option value="Fairfield">Fairfield</option>
<option value="Falls Church City">Falls Church City</option>
<option value="Fannin">Fannin</option>
<option value="Faribault">Faribault</option>
<option value="Faulkner">Faulkner</option>
<option value="Fauquier">Fauquier</option>
<option value="Fayette">Fayette</option>
<option value="Fentress">Fentress</option>
<option value="Fillmore">Fillmore</option>
<option value="Finney">Finney</option>
<option value="Flagler">Flagler</option>
<option value="Flathead">Flathead</option>
<option value="Fleming">Fleming</option>
<option value="Florence">Florence</option>
<option value="Floyd">Floyd</option>
<option value="Fluvanna">Fluvanna</option>
<option value="Fond Du Lac">Fond Du Lac</option>
<option value="Ford">Ford</option>
<option value="Forrest">Forrest</option>
<option value="Forsyth">Forsyth</option>
<option value="Fort Bend">Fort Bend</option>
<option value="Fountain">Fountain</option>
<option value="Frankfort">Frankfort</option>
<option value="Franklin">Franklin</option>
<option value="Franklin City">Franklin City</option>
<option value="Frederick">Frederick</option>
<option value="Freeborn">Freeborn</option>
<option value="Freestone">Freestone</option>
<option value="Fremont">Fremont</option>
<option value="Fresno">Fresno</option>
<option value="Fulton">Fulton</option>
<option value="Furnas">Furnas</option>
<option value="Gadsden">Gadsden</option>
<option value="Gage">Gage</option>
<option value="Galax City">Galax City</option>
<option value="Gallatin">Gallatin</option>
<option value="Gallia">Gallia</option>
<option value="Galveston">Galveston</option>
<option value="Garfield">Garfield</option>
<option value="Garland">Garland</option>
<option value="Garrard">Garrard</option>
<option value="Garrett">Garrett</option>
<option value="Gasconade">Gasconade</option>
<option value="Gaston">Gaston</option>
<option value="Geary">Geary</option>
<option value="Geauga">Geauga</option>
<option value="Genesee">Genesee</option>
<option value="Geneva">Geneva</option>
<option value="Georgetown">Georgetown</option>
<option value="Gibson">Gibson</option>
<option value="Gila">Gila</option>
<option value="Giles">Giles</option>
<option value="Gillespie">Gillespie</option>
<option value="Gilmer">Gilmer</option>
<option value="Gilpin">Gilpin</option>
<option value="Glacier">Glacier</option>
<option value="Glades">Glades</option>
<option value="Gladwin">Gladwin</option>
<option value="Glasgow">Glasgow</option>
<option value="Glasscock">Glasscock</option>
<option value="Gloucester">Gloucester</option>
<option value="Glynn">Glynn</option>
<option value="Gogebic">Gogebic</option>
<option value="Goochland">Goochland</option>
<option value="Goodhue">Goodhue</option>
<option value="Gordon">Gordon</option>
<option value="Grady">Grady</option>
<option value="Grafton">Grafton</option>
<option value="Graham">Graham</option>
<option value="Grainger">Grainger</option>
<option value="Grand Forks">Grand Forks</option>
<option value="Grand Traverse">Grand Traverse</option>
<option value="Granite">Granite</option>
<option value="Grant">Grant</option>
<option value="Granville">Granville</option>
<option value="Gratiot">Gratiot</option>
<option value="Graves">Graves</option>
<option value="Gray">Gray</option>
<option value="Grays Harbor">Grays Harbor</option>
<option value="Grayson">Grayson</option>
<option value="Green">Green</option>
<option value="Greenbrier">Greenbrier</option>
<option value="Greene">Greene</option>
<option value="Greenup">Greenup</option>
<option value="Greenville">Greenville</option>
<option value="Greenwood">Greenwood</option>
<option value="Gregg">Gregg</option>
<option value="Grenada">Grenada</option>
<option value="Grimes">Grimes</option>
<option value="Grundy">Grundy</option>
<option value="Guadalupe">Guadalupe</option>
<option value="Guam">Guam</option>
<option value="Guaynabo">Guaynabo</option>
<option value="Guernsey">Guernsey</option>
<option value="Guilford">Guilford</option>
<option value="Gulf">Gulf</option>
<option value="Gunnison">Gunnison</option>
<option value="Gwinnett">Gwinnett</option>
<option value="Haakon">Haakon</option>
<option value="Habersham">Habersham</option>
<option value="Hale">Hale</option>
<option value="Halifax">Halifax</option>
<option value="Hall">Hall</option>
<option value="Hamblen">Hamblen</option>
<option value="Hamilton">Hamilton</option>
<option value="Hampden">Hampden</option>
<option value="Hampshire">Hampshire</option>
<option value="Hampton">Hampton</option>
<option value="Hampton City">Hampton City</option>
<option value="Hancock">Hancock</option>
<option value="Hanover">Hanover</option>
<option value="Haralson">Haralson</option>
<option value="Hardee">Hardee</option>
<option value="Hardeman">Hardeman</option>
<option value="Hardin">Hardin</option>
<option value="Harford">Harford</option>
<option value="Harlan">Harlan</option>
<option value="Harnett">Harnett</option>
<option value="Harper">Harper</option>
<option value="Harris">Harris</option>
<option value="Harrison">Harrison</option>
<option value="Harrisonburg City">Harrisonburg City</option>
<option value="Hart">Hart</option>
<option value="Hartford">Hartford</option>
<option value="Harvey">Harvey</option>
<option value="Hawaii">Hawaii</option>
<option value="Hawkins">Hawkins</option>
<option value="Hays">Hays</option>
<option value="Haywood">Haywood</option>
<option value="Henderson">Henderson</option>
<option value="Hendricks">Hendricks</option>
<option value="Hendry">Hendry</option>
<option value="Hennepin">Hennepin</option>
<option value="Henrhy">Henrhy</option>
<option value="Henrico">Henrico</option>
<option value="Henry">Henry</option>
<option value="Herkimer">Herkimer</option>
<option value="Hernando">Hernando</option>
<option value="Hertford">Hertford</option>
<option value="Hickman">Hickman</option>
<option value="Hidalgo">Hidalgo</option>
<option value="Highland">Highland</option>
<option value="Highlands">Highlands</option>
<option value="Hillsborough">Hillsborough</option>
<option value="Hillsdale">Hillsdale</option>
<option value="Hinds">Hinds</option>
<option value="Hocking">Hocking</option>
<option value="Hoke">Hoke</option>
<option value="Holmes">Holmes</option>
<option value="Honolulu">Honolulu</option>
<option value="Hood">Hood</option>
<option value="Hopewell City">Hopewell City</option>
<option value="Hopkins">Hopkins</option>
<option value="Horry">Horry</option>
<option value="Hot Spring">Hot Spring</option>
<option value="Hot Springs">Hot Springs</option>
<option value="Houghton">Houghton</option>
<option value="Houston">Houston</option>
<option value="Howard">Howard</option>
<option value="Howell">Howell</option>
<option value="Hubbard">Hubbard</option>
<option value="Hudson">Hudson</option>
<option value="Humboldt">Humboldt</option>
<option value="Humphreys">Humphreys</option>
<option value="Hunt">Hunt</option>
<option value="Hunterdon">Hunterdon</option>
<option value="Huntingdon">Huntingdon</option>
<option value="Huntington">Huntington</option>
<option value="Huron">Huron</option>
<option value="Hyde">Hyde</option>
<option value="Iberia">Iberia</option>
<option value="Independence">Independence</option>
<option value="Indian River">Indian River</option>
<option value="Indiana">Indiana</option>
<option value="Ingham">Ingham</option>
<option value="Inyo">Inyo</option>
<option value="Ionia">Ionia</option>
<option value="Iosco">Iosco</option>
<option value="Iowa">Iowa</option>
<option value="Iredell">Iredell</option>
<option value="Iron">Iron</option>
<option value="Iroquois">Iroquois</option>
<option value="Isabella">Isabella</option>
<option value="Isanti">Isanti</option>
<option value="Island">Island</option>
<option value="Itasca">Itasca</option>
<option value="Itawamba">Itawamba</option>
<option value="Izard">Izard</option>
<option value="Jack">Jack</option>
<option value="Jackson">Jackson</option>
<option value="James City">James City</option>
<option value="Jasper">Jasper</option>
<option value="Jay">Jay</option>
<option value="Jefferson">Jefferson</option>
<option value="Jefferson Davis">Jefferson Davis</option>
<option value="Jennings">Jennings</option>
<option value="Jessamine">Jessamine</option>
<option value="Jo Daviess">Jo Daviess</option>
<option value="Johnson">Johnson</option>
<option value="Johnston">Johnston</option>
<option value="Jones">Jones</option>
<option value="Juneau">Juneau</option>
<option value="Kalamazoo">Kalamazoo</option>
<option value="Kalkaska">Kalkaska</option>
<option value="Kanabec">Kanabec</option>
<option value="Kanawha">Kanawha</option>
<option value="Kandiyohi">Kandiyohi</option>
<option value="Kane">Kane</option>
<option value="Kankakee">Kankakee</option>
<option value="Karnes">Karnes</option>
<option value="Kauai">Kauai</option>
<option value="Kaufman">Kaufman</option>
<option value="Kay">Kay</option>
<option value="Kenai Peninsula">Kenai Peninsula</option>
<option value="Kendall">Kendall</option>
<option value="Kennebec">Kennebec</option>
<option value="Kenosha">Kenosha</option>
<option value="Kent">Kent</option>
<option value="Kenton">Kenton</option>
<option value="Kern">Kern</option>
<option value="Kerr">Kerr</option>
<option value="Kershaw">Kershaw</option>
<option value="Ketchikan Gateway">Ketchikan Gateway</option>
<option value="King">King</option>
<option value="King George">King George</option>
<option value="Kings">Kings</option>
<option value="Kiowa">Kiowa</option>
<option value="Kitsap">Kitsap</option>
<option value="Klamath">Klamath</option>
<option value="Kleberg">Kleberg</option>
<option value="Klickitat">Klickitat</option>
<option value="Knott">Knott</option>
<option value="Knox">Knox</option>
<option value="Kodiak Island">Kodiak Island</option>
<option value="Koochiching">Koochiching</option>
<option value="Kootenai">Kootenai</option>
<option value="Kosciusko">Kosciusko</option>
<option value="La Crosse">La Crosse</option>
<option value="La Plata">La Plata</option>
<option value="La Porte">La Porte</option>
<option value="La Salle">La Salle</option>
<option value="Labette">Labette</option>
<option value="Lackawanna">Lackawanna</option>
<option value="Laclede">Laclede</option>
<option value="Lafayette">Lafayette</option>
<option value="Lafourche">Lafourche</option>
<option value="Lagrange">Lagrange</option>
<option value="Lake">Lake</option>
<option value="Lamar">Lamar</option>
<option value="Lamb">Lamb</option>
<option value="Lampasas">Lampasas</option>
<option value="Lancaster">Lancaster</option>
<option value="Lane">Lane</option>
<option value="Langlade">Langlade</option>
<option value="Lapeer">Lapeer</option>
<option value="LaPorte">LaPorte</option>
<option value="Laramie">Laramie</option>
<option value="Larimer">Larimer</option>
<option value="LaRue">LaRue</option>
<option value="Lassen">Lassen</option>
<option value="Latah">Latah</option>
<option value="Lauderdale">Lauderdale</option>
<option value="Laurel">Laurel</option>
<option value="Laurens">Laurens</option>
<option value="Lawrence">Lawrence</option>
<option value="Le Sueur">Le Sueur</option>
<option value="Leavenworth">Leavenworth</option>
<option value="Lebanon">Lebanon</option>
<option value="Lee">Lee</option>
<option value="Leelanau">Leelanau</option>
<option value="Leflore">Leflore</option>
<option value="Lehigh">Lehigh</option>
<option value="Lenawee">Lenawee</option>
<option value="Lenoir">Lenoir</option>
<option value="Leon">Leon</option>
<option value="Leslie">Leslie</option>
<option value="Letcher">Letcher</option>
<option value="Levy">Levy</option>
<option value="Lewis">Lewis</option>
<option value="Lewis and Clark">Lewis and Clark</option>
<option value="Lexington">Lexington</option>
<option value="Lexington City">Lexington City</option>
<option value="Liberty">Liberty</option>
<option value="Licking">Licking</option>
<option value="Limestone">Limestone</option>
<option value="Lincoln">Lincoln</option>
<option value="Linn">Linn</option>
<option value="Lipscomb">Lipscomb</option>
<option value="Litchfield">Litchfield</option>
<option value="Live Oak">Live Oak</option>
<option value="Livingston">Livingston</option>
<option value="Logan">Logan</option>
<option value="Long">Long</option>
<option value="Lonoke">Lonoke</option>
<option value="Lorain">Lorain</option>
<option value="Los Angeles">Los Angeles</option>
<option value="Loudon">Loudon</option>
<option value="Loudoun">Loudoun</option>
<option value="Louisa">Louisa</option>
<option value="Lowndes">Lowndes</option>
<option value="Lubbock">Lubbock</option>
<option value="Lucas">Lucas</option>
<option value="Lumpkin">Lumpkin</option>
<option value="Lunenburg">Lunenburg</option>
<option value="Luzerne">Luzerne</option>
<option value="Lycoming">Lycoming</option>
<option value="Lynchburg City">Lynchburg City</option>
<option value="Lyon">Lyon</option>
<option value="Lyons">Lyons</option>
<option value="Mackinac">Mackinac</option>
<option value="Macomb">Macomb</option>
<option value="Macon">Macon</option>
<option value="Macoupin">Macoupin</option>
<option value="Madison">Madison</option>
<option value="Magoffin">Magoffin</option>
<option value="Mahaska">Mahaska</option>
<option value="Mahoning">Mahoning</option>
<option value="Manassas City">Manassas City</option>
<option value="Manassas Park City">Manassas Park City</option>
<option value="Manatee">Manatee</option>
<option value="Manchester">Manchester</option>
<option value="Manistee">Manistee</option>
<option value="Manitowoc">Manitowoc</option>
<option value="Marathon">Marathon</option>
<option value="Maricopa">Maricopa</option>
<option value="Marin">Marin</option>
<option value="Marion">Marion</option>
<option value="Mariposa">Mariposa</option>
<option value="Marlboro">Marlboro</option>
<option value="Marquette">Marquette</option>
<option value="Marshall">Marshall</option>
<option value="Martin">Martin</option>
<option value="Martinsville City">Martinsville City</option>
<option value="Mason">Mason</option>
<option value="Massac">Massac</option>
<option value="Matanuska Susitna">Matanuska Susitna</option>
<option value="Mathews">Mathews</option>
<option value="Maui">Maui</option>
<option value="Maury">Maury</option>
<option value="Mayaguez">Mayaguez</option>
<option value="Mayes">Mayes</option>
<option value="McCormick">McCormick</option>
<option value="McCracken">McCracken</option>
<option value="McCreary">McCreary</option>
<option value="McDonough">McDonough</option>
<option value="McDowell">McDowell</option>
<option value="McDuffie">McDuffie</option>
<option value="McHenry">McHenry</option>
<option value="McKean">McKean</option>
<option value="McKenzie">McKenzie</option>
<option value="McKinley">McKinley</option>
<option value="McLean">McLean</option>
<option value="McLennan">McLennan</option>
<option value="McLeod">McLeod</option>
<option value="McLeran">McLeran</option>
<option value="McMinn">McMinn</option>
<option value="McNairy">McNairy</option>
<option value="Mead">Mead</option>
<option value="Meade">Meade</option>
<option value="Mecklenburg">Mecklenburg</option>
<option value="Mecosta">Mecosta</option>
<option value="Medina">Medina</option>
<option value="Meeker">Meeker</option>
<option value="Meigs">Meigs</option>
<option value="Menard">Menard</option>
<option value="Mendocino">Mendocino</option>
<option value="Menifee">Menifee</option>
<option value="Merced">Merced</option>
<option value="Mercer">Mercer</option>
<option value="Meriwether">Meriwether</option>
<option value="Merrick">Merrick</option>
<option value="Merrimack">Merrimack</option>
<option value="Mesa">Mesa</option>
<option value="Metcalfe">Metcalfe</option>
<option value="Miami">Miami</option>
<option value="Miami-Dade">Miami-Dade</option>
<option value="Middlesex">Middlesex</option>
<option value="Midland">Midland</option>
<option value="Millard">Millard</option>
<option value="Mille Lacs">Mille Lacs</option>
<option value="Miller">Miller</option>
<option value="Milwaukee">Milwaukee</option>
<option value="Mineral">Mineral</option>
<option value="Mingo">Mingo</option>
<option value="Minnehaha">Minnehaha</option>
<option value="Missaukee">Missaukee</option>
<option value="Mississippi">Mississippi</option>
<option value="Missoula">Missoula</option>
<option value="Mitchell">Mitchell</option>
<option value="Mobile">Mobile</option>
<option value="Moffat">Moffat</option>
<option value="Mohave">Mohave</option>
<option value="Monmouth">Monmouth</option>
<option value="Monona">Monona</option>
<option value="Monongalia">Monongalia</option>
<option value="Monroe">Monroe</option>
<option value="Montcalm">Montcalm</option>
<option value="Monterey">Monterey</option>
<option value="Montgomery">Montgomery</option>
<option value="Montour">Montour</option>
<option value="Montrose">Montrose</option>
<option value="Moore">Moore</option>
<option value="Morehouse">Morehouse</option>
<option value="Morgan">Morgan</option>
<option value="Morris">Morris</option>
<option value="Morrow">Morrow</option>
<option value="Morton">Morton</option>
<option value="Moultrie">Moultrie</option>
<option value="Mower">Mower</option>
<option value="Muhlenberg">Muhlenberg</option>
<option value="Muhlenburg">Muhlenburg</option>
<option value="Multnomah">Multnomah</option>
<option value="Murray">Murray</option>
<option value="Muscatine">Muscatine</option>
<option value="Muscogee">Muscogee</option>
<option value="Muskegon">Muskegon</option>
<option value="Muskingum">Muskingum</option>
<option value="Muskogee">Muskogee</option>
<option value="Nacogdoches">Nacogdoches</option>
<option value="Nantucket">Nantucket</option>
<option value="Napa">Napa</option>
<option value="Nash">Nash</option>
<option value="Nassau">Nassau</option>
<option value="Natchitoches">Natchitoches</option>
<option value="Natrona">Natrona</option>
<option value="Navarro">Navarro</option>
<option value="Nelson">Nelson</option>
<option value="Neshoba">Neshoba</option>
<option value="Nevada">Nevada</option>
<option value="New Castle">New Castle</option>
<option value="New Hanover">New Hanover</option>
<option value="New Haven">New Haven</option>
<option value="New Kent">New Kent</option>
<option value="New London">New London</option>
<option value="New Madrid">New Madrid</option>
<option value="New York">New York</option>
<option value="Newaygo">Newaygo</option>
<option value="Newberry">Newberry</option>
<option value="Newport">Newport</option>
<option value="Newport News City">Newport News City</option>
<option value="Newton">Newton</option>
<option value="Nez Perce">Nez Perce</option>
<option value="Niagara">Niagara</option>
<option value="Nicholas">Nicholas</option>
<option value="Nicollet">Nicollet</option>
<option value="Noble">Noble</option>
<option value="Nobles">Nobles</option>
<option value="Nodaway">Nodaway</option>
<option value="Nome">Nome</option>
<option value="Norfolk">Norfolk</option>
<option value="Norfolk City">Norfolk City</option>
<option value="Northampton">Northampton</option>
<option value="Northumberland">Northumberland</option>
<option value="Nueces">Nueces</option>
<option value="Nye">Nye</option>
<option value="Oakland">Oakland</option>
<option value="Obion">Obion</option>
<option value="Ocean">Ocean</option>
<option value="Oceana">Oceana</option>
<option value="Oconee">Oconee</option>
<option value="Oconto">Oconto</option>
<option value="Ogemaw">Ogemaw</option>
<option value="Ogle">Ogle</option>
<option value="Oglethorpe">Oglethorpe</option>
<option value="Ohio">Ohio</option>
<option value="Okaloosa">Okaloosa</option>
<option value="Okeechobee">Okeechobee</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Okmulgee">Okmulgee</option>
<option value="Oktibbeha">Oktibbeha</option>
<option value="Oldham">Oldham</option>
<option value="Olmsted">Olmsted</option>
<option value="Oneida">Oneida</option>
<option value="Onondaga">Onondaga</option>
<option value="Onslow">Onslow</option>
<option value="Ontario">Ontario</option>
<option value="Orange">Orange</option>
<option value="Orangeburg">Orangeburg</option>
<option value="Oregon">Oregon</option>
<option value="Orleans">Orleans</option>
<option value="Osage">Osage</option>
<option value="Osceola">Osceola</option>
<option value="Oscoda">Oscoda</option>
<option value="Oswego">Oswego</option>
<option value="Otero">Otero</option>
<option value="Otoe">Otoe</option>
<option value="Otsego">Otsego</option>
<option value="Ottawa">Ottawa</option>
<option value="Otter Tail">Otter Tail</option>
<option value="Ouachita">Ouachita</option>
<option value="Outagamie">Outagamie</option>
<option value="Overton">Overton</option>
<option value="Owen">Owen</option>
<option value="Owsley">Owsley</option>
<option value="Ozark">Ozark</option>
<option value="Ozaukee">Ozaukee</option>
<option value="Pacific">Pacific</option>
<option value="Page">Page</option>
<option value="Palm Beach">Palm Beach</option>
<option value="Pamlico">Pamlico</option>
<option value="Panola">Panola</option>
<option value="Park">Park</option>
<option value="Parker">Parker</option>
<option value="Parmer">Parmer</option>
<option value="Pasco">Pasco</option>
<option value="Pasquotank">Pasquotank</option>
<option value="Passaic">Passaic</option>
<option value="Paulding">Paulding</option>
<option value="Pawnee">Pawnee</option>
<option value="Payette">Payette</option>
<option value="Payne">Payne</option>
<option value="Peach">Peach</option>
<option value="Pearl River">Pearl River</option>
<option value="Pender">Pender</option>
<option value="Pendleton">Pendleton</option>
<option value="Pennington">Pennington</option>
<option value="Penobscot">Penobscot</option>
<option value="Peoria">Peoria</option>
<option value="Perquimans">Perquimans</option>
<option value="Perry">Perry</option>
<option value="Person">Person</option>
<option value="Petersburg City">Petersburg City</option>
<option value="Pettis">Pettis</option>
<option value="Phelps">Phelps</option>
<option value="Philadelphia">Philadelphia</option>
<option value="Phillips">Phillips</option>
<option value="Piatt">Piatt</option>
<option value="Pickaway">Pickaway</option>
<option value="Pickens">Pickens</option>
<option value="Pickett">Pickett</option>
<option value="Pierce">Pierce</option>
<option value="Pike">Pike</option>
<option value="Pima">Pima</option>
<option value="Pinal">Pinal</option>
<option value="Pinellas">Pinellas</option>
<option value="Pipestone">Pipestone</option>
<option value="Pitkin">Pitkin</option>
<option value="Pitt">Pitt</option>
<option value="Pittsburg">Pittsburg</option>
<option value="Pittsylvania">Pittsylvania</option>
<option value="Placer">Placer</option>
<option value="Plaquemines">Plaquemines</option>
<option value="Platte">Platte</option>
<option value="Plumas">Plumas</option>
<option value="Plymouth">Plymouth</option>
<option value="Polk">Polk</option>
<option value="Pontotoc">Pontotoc</option>
<option value="Pope">Pope</option>
<option value="Poquoson City">Poquoson City</option>
<option value="Portage">Portage</option>
<option value="Porter">Porter</option>
<option value="Portsmouth City">Portsmouth City</option>
<option value="Posey">Posey</option>
<option value="Pottawatomie">Pottawatomie</option>
<option value="Pottawattamie">Pottawattamie</option>
<option value="Potter">Potter</option>
<option value="Powell">Powell</option>
<option value="Poweshiek">Poweshiek</option>
<option value="Powhatan">Powhatan</option>
<option value="Preble">Preble</option>
<option value="Prentiss">Prentiss</option>
<option value="Presque Isle">Presque Isle</option>
<option value="Prince Edward">Prince Edward</option>
<option value="Prince George">Prince George</option>
<option value="Prince Georges">Prince Georges</option>
<option value="Prince William">Prince William</option>
<option value="Providence">Providence</option>
<option value="Pueblo">Pueblo</option>
<option value="Pulaski">Pulaski</option>
<option value="Putnam">Putnam</option>
<option value="Queen Annes">Queen Annes</option>
<option value="Queens">Queens</option>
<option value="Rabun">Rabun</option>
<option value="Racine">Racine</option>
<option value="Radford">Radford</option>
<option value="Raleigh">Raleigh</option>
<option value="Ramsey">Ramsey</option>
<option value="Randall">Randall</option>
<option value="Randolph">Randolph</option>
<option value="Rankin">Rankin</option>
<option value="Rapides">Rapides</option>
<option value="Rappahannock">Rappahannock</option>
<option value="Ravalli">Ravalli</option>
<option value="Ray">Ray</option>
<option value="Red River">Red River</option>
<option value="Redwood">Redwood</option>
<option value="Reno">Reno</option>
<option value="Rensselaer">Rensselaer</option>
<option value="Renville">Renville</option>
<option value="Rhea">Rhea</option>
<option value="Rice">Rice</option>
<option value="Richland">Richland</option>
<option value="Richmond">Richmond</option>
<option value="Richmond City">Richmond City</option>
<option value="Riley">Riley</option>
<option value="Rio Arriba">Rio Arriba</option>
<option value="Ripley">Ripley</option>
<option value="Riverside">Riverside</option>
<option value="Roane">Roane</option>
<option value="Roanoke">Roanoke</option>
<option value="Roanoke City">Roanoke City</option>
<option value="Robertson">Robertson</option>
<option value="Robeson">Robeson</option>
<option value="Rock">Rock</option>
<option value="Rock Island">Rock Island</option>
<option value="Rockbridge">Rockbridge</option>
<option value="Rockcastle">Rockcastle</option>
<option value="Rockdale">Rockdale</option>
<option value="Rockingham">Rockingham</option>
<option value="Rockland">Rockland</option>
<option value="Rockwall">Rockwall</option>
<option value="Rogers">Rogers</option>
<option value="Roosevelt">Roosevelt</option>
<option value="Roscommon">Roscommon</option>
<option value="Ross">Ross</option>
<option value="Routt">Routt</option>
<option value="Rowan">Rowan</option>
<option value="Rush">Rush</option>
<option value="Rusk">Rusk</option>
<option value="Russell">Russell</option>
<option value="Rutherford">Rutherford</option>
<option value="Rutland">Rutland</option>
<option value="Sabine">Sabine</option>
<option value="Sacramento">Sacramento</option>
<option value="Sagadahoc">Sagadahoc</option>
<option value="Saginaw">Saginaw</option>
<option value="Saint Charles">Saint Charles</option>
<option value="Saint Clair">Saint Clair</option>
<option value="Saint Croix">Saint Croix</option>
<option value="Saint Francois">Saint Francois</option>
<option value="Saint Johns">Saint Johns</option>
<option value="Saint Joseph">Saint Joseph</option>
<option value="Saint Landry">Saint Landry</option>
<option value="Saint Lawrence">Saint Lawrence</option>
<option value="Saint Louis">Saint Louis</option>
<option value="Saint Louis city">Saint Louis city</option>
<option value="Saint Lucie">Saint Lucie</option>
<option value="Saint Mary">Saint Mary</option>
<option value="Saint Marys">Saint Marys</option>
<option value="Saint Tammany">Saint Tammany</option>
<option value="Saint Thomas">Saint Thomas</option>
<option value="Sainte Genevieve">Sainte Genevieve</option>
<option value="Salem">Salem</option>
<option value="Saline">Saline</option>
<option value="Salt Lake">Salt Lake</option>
<option value="Saluda">Saluda</option>
<option value="Sampson">Sampson</option>
<option value="San Bernardino">San Bernardino</option>
<option value="San Diego">San Diego</option>
<option value="San Francisco">San Francisco</option>
<option value="San German">San German</option>
<option value="San Joaquin">San Joaquin</option>
<option value="San Juan">San Juan</option>
<option value="San Luis Obispo">San Luis Obispo</option>
<option value="San Mateo">San Mateo</option>
<option value="San Miguel">San Miguel</option>
<option value="San Patricio">San Patricio</option>
<option value="Sandoval">Sandoval</option>
<option value="Sandusky">Sandusky</option>
<option value="Sangamon">Sangamon</option>
<option value="Sanilac">Sanilac</option>
<option value="Santa Barbara">Santa Barbara</option>
<option value="Santa Clara">Santa Clara</option>
<option value="Santa Cruz">Santa Cruz</option>
<option value="Santa Fe">Santa Fe</option>
<option value="Santa Rosa">Santa Rosa</option>
<option value="Sarasota">Sarasota</option>
<option value="Saratoga">Saratoga</option>
<option value="Sarpy">Sarpy</option>
<option value="Sauk">Sauk</option>
<option value="Saunders">Saunders</option>
<option value="Sawyer">Sawyer</option>
<option value="Schenectady">Schenectady</option>
<option value="Schuyler">Schuyler</option>
<option value="Schuylkill">Schuylkill</option>
<option value="Scioto">Scioto</option>
<option value="Scotland">Scotland</option>
<option value="Scott">Scott</option>
<option value="Sebastian">Sebastian</option>
<option value="Sedgwick">Sedgwick</option>
<option value="Seminole">Seminole</option>
<option value="Seneca">Seneca</option>
<option value="Sequatchie">Sequatchie</option>
<option value="Sequoyah">Sequoyah</option>
<option value="Sevier">Sevier</option>
<option value="Shasta">Shasta</option>
<option value="Shawano">Shawano</option>
<option value="Shawnee">Shawnee</option>
<option value="Sheboygan">Sheboygan</option>
<option value="Shelby">Shelby</option>
<option value="Shelbyville">Shelbyville</option>
<option value="Shenandoah">Shenandoah</option>
<option value="Sherburne">Sherburne</option>
<option value="Sheridan">Sheridan</option>
<option value="Sherman">Sherman</option>
<option value="Shiawassee">Shiawassee</option>
<option value="Silver Bow">Silver Bow</option>
<option value="Simpson">Simpson</option>
<option value="Sioux">Sioux</option>
<option value="Siskiyou">Siskiyou</option>
<option value="Sitka">Sitka</option>
<option value="Skagit">Skagit</option>
<option value="Skamania">Skamania</option>
<option value="Smith">Smith</option>
<option value="Smyth">Smyth</option>
<option value="Snohomish">Snohomish</option>
<option value="Snyder">Snyder</option>
<option value="Solano">Solano</option>
<option value="Somerset">Somerset</option>
<option value="Sonoma">Sonoma</option>
<option value="Southampton">Southampton</option>
<option value="Spalding">Spalding</option>
<option value="Spartanburg">Spartanburg</option>
<option value="Spencer">Spencer</option>
<option value="Spokane">Spokane</option>
<option value="Spotsylvania">Spotsylvania</option>
<option value="St John the Baptist">St John the Baptist</option>
<option value="St Joseph">St Joseph</option>
<option value="Stafford">Stafford</option>
<option value="Stanislaus">Stanislaus</option>
<option value="Stanley">Stanley</option>
<option value="Stanly">Stanly</option>
<option value="Stanton">Stanton</option>
<option value="Stark">Stark</option>
<option value="Starke">Starke</option>
<option value="Staunton City">Staunton City</option>
<option value="Stearns">Stearns</option>
<option value="Stephens">Stephens</option>
<option value="Stephenson">Stephenson</option>
<option value="Steuben">Steuben</option>
<option value="Stewart">Stewart</option>
<option value="Stoddard">Stoddard</option>
<option value="Stokes">Stokes</option>
<option value="Stone">Stone</option>
<option value="Story">Story</option>
<option value="Strafford">Strafford</option>
<option value="Sublette">Sublette</option>
<option value="Suffolk">Suffolk</option>
<option value="Suffolk City">Suffolk City</option>
<option value="Sullivan">Sullivan</option>
<option value="Summers">Summers</option>
<option value="Summit">Summit</option>
<option value="Sumner">Sumner</option>
<option value="Sumter">Sumter</option>
<option value="Surry">Surry</option>
<option value="Susquehanna">Susquehanna</option>
<option value="Sussex">Sussex</option>
<option value="Suwannee">Suwannee</option>
<option value="Sweetwater">Sweetwater</option>
<option value="Switzerland">Switzerland</option>
<option value="Talbot">Talbot</option>
<option value="Talladega">Talladega</option>
<option value="Tallapoosa">Tallapoosa</option>
<option value="Taney">Taney</option>
<option value="Tangipahoa">Tangipahoa</option>
<option value="Tarrant">Tarrant</option>
<option value="Tate">Tate</option>
<option value="Taylor">Taylor</option>
<option value="Tazewell">Tazewell</option>
<option value="Tehama">Tehama</option>
<option value="Teller">Teller</option>
<option value="Terrebonne">Terrebonne</option>
<option value="Terrell">Terrell</option>
<option value="Teton">Teton</option>
<option value="Thomas">Thomas</option>
<option value="Thurston">Thurston</option>
<option value="Tift">Tift</option>
<option value="Tillamook">Tillamook</option>
<option value="Tioga">Tioga</option>
<option value="Tippecanoe">Tippecanoe</option>
<option value="Tipton">Tipton</option>
<option value="Tishomingo">Tishomingo</option>
<option value="Todd">Todd</option>
<option value="Tolland">Tolland</option>
<option value="Tompkins">Tompkins</option>
<option value="Tooele">Tooele</option>
<option value="Torrance">Torrance</option>
<option value="Towns">Towns</option>
<option value="Transylvania">Transylvania</option>
<option value="Travis">Travis</option>
<option value="Trigg">Trigg</option>
<option value="Trimble">Trimble</option>
<option value="Troup">Troup</option>
<option value="Trousdale">Trousdale</option>
<option value="Trumbull">Trumbull</option>
<option value="Tulare">Tulare</option>
<option value="Tulsa">Tulsa</option>
<option value="Tuolumne">Tuolumne</option>
<option value="Tuscaloosa">Tuscaloosa</option>
<option value="Tuscarawas">Tuscarawas</option>
<option value="Twin Falls">Twin Falls</option>
<option value="Tyler">Tyler</option>
<option value="Uinta">Uinta</option>
<option value="Uintah">Uintah</option>
<option value="Ulster">Ulster</option>
<option value="Umatilla">Umatilla</option>
<option value="Unicoi">Unicoi</option>
<option value="Union">Union</option>
<option value="Unknown">Unknown</option>
<option value="Utah">Utah</option>
<option value="Uvalde">Uvalde</option>
<option value="Val Verde">Val Verde</option>
<option value="Valencia">Valencia</option>
<option value="Valley">Valley</option>
<option value="Van Buren">Van Buren</option>
<option value="Van Wert">Van Wert</option>
<option value="Vance">Vance</option>
<option value="Vandeburgh">Vandeburgh</option>
<option value="Vandenburg">Vandenburg</option>
<option value="Vanderburg">Vanderburg</option>
<option value="Vanderburgh">Vanderburgh</option>
<option value="Vega Baja">Vega Baja</option>
<option value="Venango">Venango</option>
<option value="Ventura">Ventura</option>
<option value="Vermilion">Vermilion</option>
<option value="Vermillion">Vermillion</option>
<option value="Vernon">Vernon</option>
<option value="Victoria">Victoria</option>
<option value="Vigo">Vigo</option>
<option value="Vilas">Vilas</option>
<option value="Virginia Beach City">Virginia Beach City</option>
<option value="Volusia">Volusia</option>
<option value="Wabash">Wabash</option>
<option value="Wabasha">Wabasha</option>
<option value="Wadena">Wadena</option>
<option value="Wagoner">Wagoner</option>
<option value="Wake">Wake</option>
<option value="Wakulla">Wakulla</option>
<option value="Waldo">Waldo</option>
<option value="Walker">Walker</option>
<option value="Waller">Waller</option>
<option value="Wallowa">Wallowa</option>
<option value="Walton">Walton</option>
<option value="Walworth">Walworth</option>
<option value="Wapello">Wapello</option>
<option value="Ward">Ward</option>
<option value="Warren">Warren</option>
<option value="Warrick">Warrick</option>
<option value="Wasatch">Wasatch</option>
<option value="Wasco">Wasco</option>
<option value="Waseca">Waseca</option>
<option value="Washakie">Washakie</option>
<option value="Washburn">Washburn</option>
<option value="Washington">Washington</option>
<option value="Washoe">Washoe</option>
<option value="Washtenaw">Washtenaw</option>
<option value="Watauga">Watauga</option>
<option value="Waukesha">Waukesha</option>
<option value="Waupaca">Waupaca</option>
<option value="Waushara">Waushara</option>
<option value="Wayne">Wayne</option>
<option value="Waynesboro City">Waynesboro City</option>
<option value="Weakley">Weakley</option>
<option value="Webb">Webb</option>
<option value="Weber">Weber</option>
<option value="Webster">Webster</option>
<option value="Weld">Weld</option>
<option value="Wells">Wells</option>
<option value="West Baton Rouge">West Baton Rouge</option>
<option value="West Feliciana">West Feliciana</option>
<option value="Westchester">Westchester</option>
<option value="Westmoreland">Westmoreland</option>
<option value="Wetzel">Wetzel</option>
<option value="Wexford">Wexford</option>
<option value="Whatcom">Whatcom</option>
<option value="Wheeler">Wheeler</option>
<option value="White">White</option>
<option value="Whiteside">Whiteside</option>
<option value="Whitfield">Whitfield</option>
<option value="Whitley">Whitley</option>
<option value="Wichita">Wichita</option>
<option value="Wicomico">Wicomico</option>
<option value="Wilcox">Wilcox</option>
<option value="Wilkes">Wilkes</option>
<option value="Will">Will</option>
<option value="Williams">Williams</option>
<option value="Williamsburg City">Williamsburg City</option>
<option value="Williamson">Williamson</option>
<option value="Wilson">Wilson</option>
<option value="Winchester City">Winchester City</option>
<option value="Windham">Windham</option>
<option value="Windsor">Windsor</option>
<option value="Winkler">Winkler</option>
<option value="Winnebago">Winnebago</option>
<option value="Winneshiek">Winneshiek</option>
<option value="Winona">Winona</option>
<option value="Wise">Wise</option>
<option value="Wolfe">Wolfe</option>
<option value="Wood">Wood</option>
<option value="Woodbury">Woodbury</option>
<option value="Woodford">Woodford</option>
<option value="Woodward">Woodward</option>
<option value="Woodword">Woodword</option>
<option value="Worcester">Worcester</option>
<option value="Wright">Wright</option>
<option value="Wyandotte">Wyandotte</option>
<option value="Wyoming">Wyoming</option>
<option value="Wythe">Wythe</option>
<option value="Yadkin">Yadkin</option>
<option value="Yakima">Yakima</option>
<option value="Yamhill">Yamhill</option>
<option value="Yancey">Yancey</option>
<option value="Yankton">Yankton</option>
<option value="Yavapai">Yavapai</option>
<option value="Yazoo">Yazoo</option>
<option value="Yellowstone">Yellowstone</option>
<option value="Yolo">Yolo</option>
<option value="York">York</option>
<option value="Yuba">Yuba</option>
<option value="Yuma">Yuma</option>
</select>
</div>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="2" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_txtUKPostCode" id="bboxdonation_tribute_tributeAddress_lblUKPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">Postcode:</label>
<input name="bboxdonation$tribute$tributeAddress$txtUKPostCode" type="text" id="bboxdonation_tribute_tributeAddress_txtUKPostCode" class="BBFormTextbox" data-country-field="postcode" data-country-sync="1" required="required"
maxlength="12">
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="3" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_txtCACity" id="bboxdonation_tribute_tributeAddress_lblCACity" class="BBFormFieldLabel BBFormFieldLabelEdit">City:</label>
<input name="bboxdonation$tribute$tributeAddress$txtCACity" type="text" id="bboxdonation_tribute_tributeAddress_txtCACity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50">
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="3" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_ddCAProvince" id="bboxdonation_tribute_tributeAddress_lblCAProvincePostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">Province & postal:</label>
<div aria-describedby="bboxdonation_tribute_tributeAddress_ddCAProvince">
<span id="bboxdonation_tribute_tributeAddress_lblCAProvince" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Province:</span>
</div>
<select name="bboxdonation$tribute$tributeAddress$ddCAProvince" id="bboxdonation_tribute_tributeAddress_ddCAProvince" class="BBFormSelectList GhostText" data-country-sync="1" data-country-field="state" required="required">
<option selected="selected" value="" default="default">province</option>
<option value="Non">Non</option>
<option value="AA">AA</option>
<option value="AB">AB</option>
<option value="AE">AE</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AP">AP</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="BC">BC</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="CZ">CZ</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MB">MB</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NB">NB</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NL">NL</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NS">NS</option>
<option value="NT">NT</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="ON">ON</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PE">PE</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="QC">QC</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="SK">SK</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="YT">YT</option>
<option value="NU">NU</option>
<option value="VIC">VIC</option>
</select>
<label for="bboxdonation_tribute_tributeAddress_txtCAPostCode" id="bboxdonation_tribute_tributeAddress_lblCAPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Postal:</label>
<input name="bboxdonation$tribute$tributeAddress$txtCAPostCode" type="text" id="bboxdonation_tribute_tributeAddress_txtCAPostCode" class="BBFormTextbox" required="required" data-country-sync="1" data-country-field="postcode"
maxlength="12" placeholder="postal">
</div>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="4" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_txtAUCity" id="bboxdonation_tribute_tributeAddress_lblAUCity" class="BBFormFieldLabel BBFormFieldLabelEdit">Suburb:</label>
<input name="bboxdonation$tribute$tributeAddress$txtAUCity" type="text" id="bboxdonation_tribute_tributeAddress_txtAUCity" class="BBFormTextbox" data-country-sync="1" data-country-field="city" required="required" maxlength="50">
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="4" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_ddAUState" id="bboxdonation_tribute_tributeAddress_lblAUStatePostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">State & postcode:</label>
<div aria-describedby="bboxdonation_tribute_tributeAddress_ddAUState">
<span id="bboxdonation_tribute_tributeAddress_lblAUState" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">State:</span>
</div>
<select name="bboxdonation$tribute$tributeAddress$ddAUState" id="bboxdonation_tribute_tributeAddress_ddAUState" class="BBFormSelectList GhostText" data-country-sync="1" data-country-field="state" required="required">
<option selected="selected" value="" default="default">state</option>
<option value="Non">Non</option>
<option value="AA">AA</option>
<option value="AB">AB</option>
<option value="AE">AE</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AP">AP</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="BC">BC</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="CZ">CZ</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MB">MB</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NB">NB</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NL">NL</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NS">NS</option>
<option value="NT">NT</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="ON">ON</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PE">PE</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="QC">QC</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="SK">SK</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="YT">YT</option>
<option value="NU">NU</option>
<option value="VIC">VIC</option>
</select>
<label for="bboxdonation_tribute_tributeAddress_txtAUPostCode" id="bboxdonation_tribute_tributeAddress_lblAUPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Postcode:</label>
<input name="bboxdonation$tribute$tributeAddress$txtAUPostCode" type="tel" id="bboxdonation_tribute_tributeAddress_txtAUPostCode" class="BBFormTextbox" required="required" data-country-sync="1" data-country-field="postcode"
maxlength="12" placeholder="postcode">
</div>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="5" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_ddNZSuburb" id="bboxdonation_tribute_tributeAddress_lblNZSuburb" class="BBFormFieldLabel BBFormFieldLabelEdit">Suburb:</label>
<select name="bboxdonation$tribute$tributeAddress$ddNZSuburb" id="bboxdonation_tribute_tributeAddress_ddNZSuburb" class="BBFormSelectList GhostText" required="required" data-country-field="nzsuburb">
<option selected="selected" value="" default="default">suburb</option>
</select>
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="5" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_ddNZCity" id="bboxdonation_tribute_tributeAddress_lblNZCityPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">City & post code:</label>
<div aria-describedby="bboxdonation_tribute_tributeAddress_ddNZCity">
<span id="bboxdonation_tribute_tributeAddress_lblNZCity" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">City:</span>
</div>
<select name="bboxdonation$tribute$tributeAddress$ddNZCity" id="bboxdonation_tribute_tributeAddress_ddNZCity" class="BBFormSelectList GhostText" required="required" data-country-field="nzcity">
<option selected="selected" value="" default="default">city</option>
</select>
<label for="bboxdonation_tribute_tributeAddress_txtNZPostCode" id="bboxdonation_tribute_tributeAddress_lblNZPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Post code:</label>
<input name="bboxdonation$tribute$tributeAddress$txtNZPostCode" type="tel" id="bboxdonation_tribute_tributeAddress_txtNZPostCode" class="BBFormTextbox" required="required" data-country-sync="1" data-country-field="postcode"
maxlength="12" placeholder="post code">
</div>
</div>
</div>
</div>
</div>
</div>
</fieldset>
</div>
<div class="BBFormSection BBDFormSectionComments">
<fieldset>
<legend></legend>
<div id="bboxdonation_comment_fldComments" class="BBFormFieldContainer">
<label for="bboxdonation_comment_txtComments" id="bboxdonation_comment_lblComments" class="BBFormFieldLabel BBFormFieldLabelEdit">Leave a comment (optional):</label>
<textarea name="bboxdonation$comment$txtComments" id="bboxdonation_comment_txtComments" class="BBFormTextArea" rows="2" cols="30" maxlength="255" placeholder="optional"></textarea>
</div>
</fieldset>
</div>
<div id="bboxdonation_designation_divSection" class="BBFormSection BBDFormSectionDesignationInfo">
<fieldset>
<legend>
<div class="BBFormSectionHeading">
<label id="bboxdonation_designation_lblHeadingDesignation" class="BBFormFieldLabelEdit">Designation</label>
</div>
</legend>
<div class="BBFormFieldContainer">
<label for="bboxdonation_designation_ddDesignations" id="bboxdonation_designation_lblDesignation" class="BBFormFieldLabel BBFormFieldLabelEdit">Designation:</label>
<select name="bboxdonation$designation$ddDesignations" id="bboxdonation_designation_ddDesignations" class="BBFormSelectList">
<option value="499">Wendy Novak Diabetes Institute</option>
<option value="593">Novak Center for Children's Health</option>
</select>
<label for="bboxdonation_designation_txtOtherDesignation" id="bboxdonation_designation_lblOtherDesignation" style="display: none;">other Designation:</label>
<input name="bboxdonation$designation$txtOtherDesignation" type="text" id="bboxdonation_designation_txtOtherDesignation" class="BBFormTextbox BBFormOtherDesignation" placeholder="other designation (optional)" style="display: none;">
</div>
<div class="BBFormFieldContainer BBFormOtherDesignationContatiner" style="display: none;">
</div>
</fieldset>
</div>
<div id="bboxdonation_billing_divBillingSection" class="BBFormSection BBDFormSectionBillingInfo BBFormAddressBlock" data-section="Billing">
<fieldset>
<legend>
<div id="bboxdonation_billing_divBillingHeader" class="BBFormSectionHeading">
<label id="bboxdonation_billing_lblHeadingContact" class="BBFormFieldLabelEdit">Billing Address</label>
</div>
</legend>
<div id="fldOrgInfo" class="BBFormOrgFields" style="display: none;">
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="bboxdonation_billing_txtOrgName" id="bboxdonation_billing_lblOrgName" class="BBFormFieldLabel BBFormFieldLabelEdit ">Organization name:</label>
<input name="bboxdonation$billing$txtOrgName" type="text" id="bboxdonation_billing_txtOrgName" class="BBFormTextbox" required="required" data-billing-field="orgname" maxlength="60">
</div>
</div>
<div id="fldIndivInfo" class="BBFormIndivFields">
<div id="divName" class="BBFormFieldContainer BBFormFieldContainerRequired BBTwoFields">
<span id="bboxdonation_billing_lblFullName" class="BBFormFieldLabel BBFormFieldLabelEdit">Name:</span>
<label for="bboxdonation_billing_ddTitle" id="bboxdonation_billing_lblTitle" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Title:</label>
<label for="bboxdonation_billing_txtFirstName" id="bboxdonation_billing_lblFirstName" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">First name:</label>
<input name="bboxdonation$billing$txtFirstName" type="text" id="bboxdonation_billing_txtFirstName" class="BBFormTextbox" data-billing-field="firstname" maxlength="50" required="required" placeholder="first name">
<label for="bboxdonation_billing_txtLastName" id="bboxdonation_billing_lblLastName" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Last name:</label>
<input name="bboxdonation$billing$txtLastName" type="text" id="bboxdonation_billing_txtLastName" class="BBFormTextbox" data-billing-field="lastname" maxlength="100" required="required" placeholder="last name">
</div>
</div>
<div id="bboxdonation_billing_divEmail" class="BBFormFieldContainer BBFormFieldContainerRequired BBFormBillingEmail">
<label for="bboxdonation_billing_txtEmail" id="bboxdonation_billing_lblEmail" class="BBFormFieldLabel BBFormFieldLabelEdit">Email:</label>
<input name="bboxdonation$billing$txtEmail" type="email" id="bboxdonation_billing_txtEmail" class="BBFormTextbox" data-billing-field="email" required="required">
</div>
<div class="BBFormAddress">
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="bboxdonation_billing_billingAddress_ddCountry" id="bboxdonation_billing_billingAddress_lblCountry" class="BBFormFieldLabel BBFormFieldLabelEdit">Country:</label>
<select name="bboxdonation$billing$billingAddress$ddCountry" id="bboxdonation_billing_billingAddress_ddCountry" class="BBFormSelectList BBFormCountryDropDown" required="required">
<option selected="selected" value="United States" data-country-format="1" data-short-text="US">United States</option>
<option value="Canada" data-country-format="3" data-short-text="CA">Canada</option>
<option value="United Kingdom" data-country-format="2" data-short-text="GB">United Kingdom</option>
<option value="Australia" data-country-format="4" data-short-text="AU">Australia</option>
<option value="New Zealand" data-country-format="5" data-short-text="NZ">New Zealand</option>
</select>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="bboxdonation_billing_billingAddress_txtAddress" id="bboxdonation_billing_billingAddress_lblAddress" class="BBFormFieldLabel BBFormFieldLabelEdit">Address:</label>
<textarea name="bboxdonation$billing$billingAddress$txtAddress" id="bboxdonation_billing_billingAddress_txtAddress" class="BBFormTextArea" rows="2" cols="30" required="required" data-country-field="address" maxlength="150"></textarea>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="1">
<label for="bboxdonation_billing_billingAddress_txtCity" id="bboxdonation_billing_billingAddress_lblCity" class="BBFormFieldLabel BBFormFieldLabelEdit">City:</label>
<input name="bboxdonation$billing$billingAddress$txtCity" type="text" id="bboxdonation_billing_billingAddress_txtCity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50">
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="1">
<label for="bboxdonation_billing_billingAddress_ddState" id="bboxdonation_billing_billingAddress_lblStateZip" class="BBFormFieldLabel BBFormFieldLabelEdit">State & zip:</label>
<div aria-describedby="bboxdonation_billing_billingAddress_ddState">
<span id="bboxdonation_billing_billingAddress_lblState" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">State:</span>
</div>
<select name="bboxdonation$billing$billingAddress$ddState" id="bboxdonation_billing_billingAddress_ddState" class="BBFormSelectList GhostText" data-country-sync="1" data-country-field="state" required="required">
<option selected="selected" value="" default="default">state</option>
<option value="Non">Non</option>
<option value="AA">AA</option>
<option value="AB">AB</option>
<option value="AE">AE</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AP">AP</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="BC">BC</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="CZ">CZ</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MB">MB</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NB">NB</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NL">NL</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NS">NS</option>
<option value="NT">NT</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="ON">ON</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PE">PE</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="QC">QC</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="SK">SK</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="YT">YT</option>
<option value="NU">NU</option>
<option value="VIC">VIC</option>
</select>
<label for="bboxdonation_billing_billingAddress_txtZip" id="bboxdonation_billing_billingAddress_lblZip" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Zip:</label>
<input name="bboxdonation$billing$billingAddress$txtZip" type="tel" id="bboxdonation_billing_billingAddress_txtZip" class="BBFormTextbox" data-country-field="postcode" data-country-sync="1" required="required" maxlength="12"
placeholder="zip">
</div>
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="2" style="display: none;">
<label for="bboxdonation_billing_billingAddress_txtUKCity" id="bboxdonation_billing_billingAddress_lblUKCityCounty" class="BBFormFieldLabel BBFormFieldLabelEdit">City & county:</label>
<div aria-describedby="bboxdonation_billing_billingAddress_txtUKCity">
<span id="bboxdonation_billing_billingAddress_lblUKCity" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">City:</span>
</div>
<input name="bboxdonation$billing$billingAddress$txtUKCity" type="text" id="bboxdonation_billing_billingAddress_txtUKCity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50"
placeholder="city">
<label for="bboxdonation_billing_billingAddress_ddUKCounty" id="bboxdonation_billing_billingAddress_lblUKCounty" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">County:</label>
<select name="bboxdonation$billing$billingAddress$ddUKCounty" id="bboxdonation_billing_billingAddress_ddUKCounty" class="BBFormSelectList GhostText" data-country-field="county">
<option selected="selected" value="" default="default">county (optional)</option>
<option value="Alamosa">Alamosa</option>
<option value="Angelina">Angelina</option>
<option value="Calaveras">Calaveras</option>
<option value="Cleburne">Cleburne</option>
<option value="Del Norte">Del Norte</option>
<option value="Dunklin">Dunklin</option>
<option value="Kittitas">Kittitas</option>
<option value="McPherson">McPherson</option>
<option value="Montezuma">Montezuma</option>
<option value="Sutter">Sutter</option>
<option value="97086">97086</option>
<option value="Ada">Ada</option>
<option value="Adair">Adair</option>
<option value="Adams">Adams</option>
<option value="Aiken">Aiken</option>
<option value="Alachua">Alachua</option>
<option value="Alamance">Alamance</option>
<option value="Alameda">Alameda</option>
<option value="Albany">Albany</option>
<option value="Albemarle">Albemarle</option>
<option value="Alcorn">Alcorn</option>
<option value="Alexander">Alexander</option>
<option value="Alexandria City">Alexandria City</option>
<option value="Alfalfa">Alfalfa</option>
<option value="Alger">Alger</option>
<option value="Allegan">Allegan</option>
<option value="Allegany">Allegany</option>
<option value="Alleghany">Alleghany</option>
<option value="Allegheny">Allegheny</option>
<option value="Allen">Allen</option>
<option value="Alpena">Alpena</option>
<option value="Amherst">Amherst</option>
<option value="Anchorage">Anchorage</option>
<option value="Anderson">Anderson</option>
<option value="Androscoggin">Androscoggin</option>
<option value="Anne Arundel">Anne Arundel</option>
<option value="Anoka">Anoka</option>
<option value="Antrim">Antrim</option>
<option value="Appanoose">Appanoose</option>
<option value="Appomattox">Appomattox</option>
<option value="Aransas">Aransas</option>
<option value="Arapahoe">Arapahoe</option>
<option value="Archuleta">Archuleta</option>
<option value="Arenac">Arenac</option>
<option value="Arlington">Arlington</option>
<option value="Armstrong">Armstrong</option>
<option value="Aroostook">Aroostook</option>
<option value="Ascension">Ascension</option>
<option value="Ashe">Ashe</option>
<option value="Ashland">Ashland</option>
<option value="Ashtabula">Ashtabula</option>
<option value="Atchison">Atchison</option>
<option value="Athens">Athens</option>
<option value="Atkinson">Atkinson</option>
<option value="Atlantic">Atlantic</option>
<option value="Auglaize">Auglaize</option>
<option value="Austin">Austin</option>
<option value="Autauga">Autauga</option>
<option value="Avery">Avery</option>
<option value="Avoyelles">Avoyelles</option>
<option value="Bailey">Bailey</option>
<option value="Baker">Baker</option>
<option value="Baldwin">Baldwin</option>
<option value="Ballard">Ballard</option>
<option value="Baltimore">Baltimore</option>
<option value="Baltimore City">Baltimore City</option>
<option value="Bandera">Bandera</option>
<option value="Bannock">Bannock</option>
<option value="Barbour">Barbour</option>
<option value="Barnstable">Barnstable</option>
<option value="Barnwell">Barnwell</option>
<option value="Barren">Barren</option>
<option value="Barrow">Barrow</option>
<option value="Barry">Barry</option>
<option value="Bartholomew">Bartholomew</option>
<option value="Bartow">Bartow</option>
<option value="Bastrop">Bastrop</option>
<option value="Bath">Bath</option>
<option value="Baxter">Baxter</option>
<option value="Bay">Bay</option>
<option value="Beaufort">Beaufort</option>
<option value="Beauregard">Beauregard</option>
<option value="Beaver">Beaver</option>
<option value="Becker">Becker</option>
<option value="Beckham">Beckham</option>
<option value="Bedford">Bedford</option>
<option value="Bee">Bee</option>
<option value="Belknap">Belknap</option>
<option value="Bell">Bell</option>
<option value="Belmont">Belmont</option>
<option value="Bennington">Bennington</option>
<option value="Benton">Benton</option>
<option value="Benzie">Benzie</option>
<option value="Bergen">Bergen</option>
<option value="Berkeley">Berkeley</option>
<option value="Berks">Berks</option>
<option value="Berkshire">Berkshire</option>
<option value="Bernalillo">Bernalillo</option>
<option value="Berrien">Berrien</option>
<option value="Bexar">Bexar</option>
<option value="Bibb">Bibb</option>
<option value="Big Horn">Big Horn</option>
<option value="Black Hawk">Black Hawk</option>
<option value="Blackford">Blackford</option>
<option value="Blaine">Blaine</option>
<option value="Blair">Blair</option>
<option value="Bleckley">Bleckley</option>
<option value="Bledsoe">Bledsoe</option>
<option value="Blount">Blount</option>
<option value="Bollinger">Bollinger</option>
<option value="Bond">Bond</option>
<option value="Bonner">Bonner</option>
<option value="Bonneville">Bonneville</option>
<option value="Boone">Boone</option>
<option value="Bossier">Bossier</option>
<option value="Botetourt">Botetourt</option>
<option value="Boulder">Boulder</option>
<option value="Bourbon">Bourbon</option>
<option value="Bowie">Bowie</option>
<option value="Boyce">Boyce</option>
<option value="Boyd">Boyd</option>
<option value="Boyle">Boyle</option>
<option value="Bracken">Bracken</option>
<option value="Bradford">Bradford</option>
<option value="Bradley">Bradley</option>
<option value="Branch">Branch</option>
<option value="Braxton">Braxton</option>
<option value="Brazoria">Brazoria</option>
<option value="Brazos">Brazos</option>
<option value="Breathitt">Breathitt</option>
<option value="Breckenridge">Breckenridge</option>
<option value="Breckinridge">Breckinridge</option>
<option value="Bremer">Bremer</option>
<option value="Brevard">Brevard</option>
<option value="Brewster">Brewster</option>
<option value="Bristol">Bristol</option>
<option value="Bristol City">Bristol City</option>
<option value="Bronx">Bronx</option>
<option value="Brooks">Brooks</option>
<option value="Broome">Broome</option>
<option value="Broomfield">Broomfield</option>
<option value="Broward">Broward</option>
<option value="Brown">Brown</option>
<option value="Brunswick">Brunswick</option>
<option value="Bryan">Bryan</option>
<option value="Buchanan">Buchanan</option>
<option value="Bucks">Bucks</option>
<option value="Buena Vista">Buena Vista</option>
<option value="Buena Vista City">Buena Vista City</option>
<option value="Buffalo">Buffalo</option>
<option value="Bullitt">Bullitt</option>
<option value="Bulloch">Bulloch</option>
<option value="Buncombe">Buncombe</option>
<option value="Bureau">Bureau</option>
<option value="Burke">Burke</option>
<option value="Burleigh">Burleigh</option>
<option value="Burleson">Burleson</option>
<option value="Burlington">Burlington</option>
<option value="Burnet">Burnet</option>
<option value="Burnett">Burnett</option>
<option value="Butler">Butler</option>
<option value="Butte">Butte</option>
<option value="Butts">Butts</option>
<option value="Cabarrus">Cabarrus</option>
<option value="Cabell">Cabell</option>
<option value="Cache">Cache</option>
<option value="Caddo">Caddo</option>
<option value="Calcasieu">Calcasieu</option>
<option value="Caldwell">Caldwell</option>
<option value="Caledonia">Caledonia</option>
<option value="Calhoun">Calhoun</option>
<option value="Callahan">Callahan</option>
<option value="Callaway">Callaway</option>
<option value="Calloway">Calloway</option>
<option value="Calvert">Calvert</option>
<option value="Cambria">Cambria</option>
<option value="Camden">Camden</option>
<option value="Cameron">Cameron</option>
<option value="Campbell">Campbell</option>
<option value="Canadian">Canadian</option>
<option value="Cannon">Cannon</option>
<option value="Canyon">Canyon</option>
<option value="Cape Girardeau">Cape Girardeau</option>
<option value="Cape May">Cape May</option>
<option value="Carbon">Carbon</option>
<option value="Caribou">Caribou</option>
<option value="Carlisle">Carlisle</option>
<option value="Carlton">Carlton</option>
<option value="Caroline">Caroline</option>
<option value="Carroll">Carroll</option>
<option value="Carrollton">Carrollton</option>
<option value="Carson City">Carson City</option>
<option value="Carter">Carter</option>
<option value="Carteret">Carteret</option>
<option value="Carver">Carver</option>
<option value="Cascade">Cascade</option>
<option value="Casey">Casey</option>
<option value="Cass">Cass</option>
<option value="Catawba">Catawba</option>
<option value="Catoosa">Catoosa</option>
<option value="Cattaraugus">Cattaraugus</option>
<option value="Cayuga">Cayuga</option>
<option value="Cecil">Cecil</option>
<option value="Cedar">Cedar</option>
<option value="Centre">Centre</option>
<option value="Cerro Gordo">Cerro Gordo</option>
<option value="Chambers">Chambers</option>
<option value="Champaign">Champaign</option>
<option value="Chariton">Chariton</option>
<option value="Charles">Charles</option>
<option value="Charleston">Charleston</option>
<option value="Charlevoix">Charlevoix</option>
<option value="Charlotte">Charlotte</option>
<option value="Charlottesville City">Charlottesville City</option>
<option value="Chase">Chase</option>
<option value="Chatham">Chatham</option>
<option value="Chattahoochee">Chattahoochee</option>
<option value="Chattooga">Chattooga</option>
<option value="Chautauqua">Chautauqua</option>
<option value="Chaves">Chaves</option>
<option value="Cheatham">Cheatham</option>
<option value="Cheboygan">Cheboygan</option>
<option value="Chelan">Chelan</option>
<option value="Chemung">Chemung</option>
<option value="Chenango">Chenango</option>
<option value="Cherokee">Cherokee</option>
<option value="Cherry">Cherry</option>
<option value="Chesapeake City">Chesapeake City</option>
<option value="Cheshire">Cheshire</option>
<option value="Chester">Chester</option>
<option value="Chesterfield">Chesterfield</option>
<option value="Cheyenne">Cheyenne</option>
<option value="Chickasaw">Chickasaw</option>
<option value="Childress">Childress</option>
<option value="Chilton">Chilton</option>
<option value="Chippewa">Chippewa</option>
<option value="Chisago">Chisago</option>
<option value="Chittenden">Chittenden</option>
<option value="Chowan">Chowan</option>
<option value="Christian">Christian</option>
<option value="Churchill">Churchill</option>
<option value="Citrus">Citrus</option>
<option value="Clackamas">Clackamas</option>
<option value="Cladwell">Cladwell</option>
<option value="Claek">Claek</option>
<option value="Claiborne">Claiborne</option>
<option value="Clallam">Clallam</option>
<option value="Clare">Clare</option>
<option value="Clarendon">Clarendon</option>
<option value="Clark">Clark</option>
<option value="Clarke">Clarke</option>
<option value="Clarl">Clarl</option>
<option value="Clatsop">Clatsop</option>
<option value="Clay">Clay</option>
<option value="Clayton">Clayton</option>
<option value="Clear Creek">Clear Creek</option>
<option value="Clermont">Clermont</option>
<option value="Cleveland">Cleveland</option>
<option value="Clinton">Clinton</option>
<option value="Cobb">Cobb</option>
<option value="Cochise">Cochise</option>
<option value="Cocke">Cocke</option>
<option value="Coconino">Coconino</option>
<option value="Coffee">Coffee</option>
<option value="Colbert">Colbert</option>
<option value="Cole">Cole</option>
<option value="Coleman">Coleman</option>
<option value="Coles">Coles</option>
<option value="Colfax">Colfax</option>
<option value="Colleton">Colleton</option>
<option value="Collier">Collier</option>
<option value="Collin">Collin</option>
<option value="Colonial Heights City">Colonial Heights City</option>
<option value="Colorado">Colorado</option>
<option value="Colquitt">Colquitt</option>
<option value="Columbia">Columbia</option>
<option value="Columbiana">Columbiana</option>
<option value="Columbus">Columbus</option>
<option value="Colusa">Colusa</option>
<option value="Comal">Comal</option>
<option value="Comanche">Comanche</option>
<option value="Contra Costa">Contra Costa</option>
<option value="Converse">Converse</option>
<option value="Conway">Conway</option>
<option value="Cook">Cook</option>
<option value="Cooper">Cooper</option>
<option value="Coos">Coos</option>
<option value="Cortland">Cortland</option>
<option value="Coryell">Coryell</option>
<option value="Coshocton">Coshocton</option>
<option value="Covington">Covington</option>
<option value="Coweta">Coweta</option>
<option value="Cowley">Cowley</option>
<option value="Cowlitz">Cowlitz</option>
<option value="Craig">Craig</option>
<option value="Craighead">Craighead</option>
<option value="Craven">Craven</option>
<option value="Crawford">Crawford</option>
<option value="Creek">Creek</option>
<option value="Crestwood">Crestwood</option>
<option value="Crittenden">Crittenden</option>
<option value="Crittendon">Crittendon</option>
<option value="Cross">Cross</option>
<option value="Crow Wing">Crow Wing</option>
<option value="Cullman">Cullman</option>
<option value="Culpeper">Culpeper</option>
<option value="Cumberland">Cumberland</option>
<option value="Curry">Curry</option>
<option value="Custer">Custer</option>
<option value="Cuyahoga">Cuyahoga</option>
<option value="Dade">Dade</option>
<option value="Dakota">Dakota</option>
<option value="Dale">Dale</option>
<option value="Dallas">Dallas</option>
<option value="Dane">Dane</option>
<option value="Danville City">Danville City</option>
<option value="Dare">Dare</option>
<option value="Darke">Darke</option>
<option value="Darlington">Darlington</option>
<option value="Dauphin">Dauphin</option>
<option value="Davidson">Davidson</option>
<option value="Davie">Davie</option>
<option value="Daviess">Daviess</option>
<option value="Davis">Davis</option>
<option value="Davison">Davison</option>
<option value="Dawes">Dawes</option>
<option value="Dawson">Dawson</option>
<option value="De Kalb">De Kalb</option>
<option value="De Soto">De Soto</option>
<option value="Dearborn">Dearborn</option>
<option value="Decatur">Decatur</option>
<option value="Defiance">Defiance</option>
<option value="Dekalb">Dekalb</option>
<option value="Delaware">Delaware</option>
<option value="Delta">Delta</option>
<option value="Dent">Dent</option>
<option value="Denton">Denton</option>
<option value="Denver">Denver</option>
<option value="Des Moines">Des Moines</option>
<option value="Deschutes">Deschutes</option>
<option value="DeSoto">DeSoto</option>
<option value="Deuel">Deuel</option>
<option value="Dewitt">Dewitt</option>
<option value="Dickinson">Dickinson</option>
<option value="Dickson">Dickson</option>
<option value="Dillon">Dillon</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Dodge">Dodge</option>
<option value="Dolores">Dolores</option>
<option value="Dona Ana">Dona Ana</option>
<option value="Door">Door</option>
<option value="Dorchester">Dorchester</option>
<option value="Dougherty">Dougherty</option>
<option value="Douglas">Douglas</option>
<option value="Drew">Drew</option>
<option value="Dubois">Dubois</option>
<option value="Dubuque">Dubuque</option>
<option value="Dukes">Dukes</option>
<option value="Dunn">Dunn</option>
<option value="Dupage">Dupage</option>
<option value="Duplin">Duplin</option>
<option value="Durham">Durham</option>
<option value="Dutchess">Dutchess</option>
<option value="Duval">Duval</option>
<option value="Dyer">Dyer</option>
<option value="Eagle">Eagle</option>
<option value="Early">Early</option>
<option value="East Baton Rouge">East Baton Rouge</option>
<option value="Eaton">Eaton</option>
<option value="Eau Claire">Eau Claire</option>
<option value="Ector">Ector</option>
<option value="Edgar">Edgar</option>
<option value="Edgecombe">Edgecombe</option>
<option value="Edgefield">Edgefield</option>
<option value="Edmondson">Edmondson</option>
<option value="Edmonson">Edmonson</option>
<option value="Edmonton">Edmonton</option>
<option value="Edwards">Edwards</option>
<option value="Effingham">Effingham</option>
<option value="El Dorado">El Dorado</option>
<option value="El Paso">El Paso</option>
<option value="Elbert">Elbert</option>
<option value="Elkhart">Elkhart</option>
<option value="Elliott">Elliott</option>
<option value="Ellis">Ellis</option>
<option value="Elmore">Elmore</option>
<option value="Emanuel">Emanuel</option>
<option value="Emmet">Emmet</option>
<option value="Erie">Erie</option>
<option value="Escambia">Escambia</option>
<option value="Essex">Essex</option>
<option value="Estill">Estill</option>
<option value="Etowah">Etowah</option>
<option value="Evans">Evans</option>
<option value="Fairbanks North Star">Fairbanks North Star</option>
<option value="Fairfax">Fairfax</option>
<option value="Fairfax City">Fairfax City</option>
<option value="Fairfield">Fairfield</option>
<option value="Falls Church City">Falls Church City</option>
<option value="Fannin">Fannin</option>
<option value="Faribault">Faribault</option>
<option value="Faulkner">Faulkner</option>
<option value="Fauquier">Fauquier</option>
<option value="Fayette">Fayette</option>
<option value="Fentress">Fentress</option>
<option value="Fillmore">Fillmore</option>
<option value="Finney">Finney</option>
<option value="Flagler">Flagler</option>
<option value="Flathead">Flathead</option>
<option value="Fleming">Fleming</option>
<option value="Florence">Florence</option>
<option value="Floyd">Floyd</option>
<option value="Fluvanna">Fluvanna</option>
<option value="Fond Du Lac">Fond Du Lac</option>
<option value="Ford">Ford</option>
<option value="Forrest">Forrest</option>
<option value="Forsyth">Forsyth</option>
<option value="Fort Bend">Fort Bend</option>
<option value="Fountain">Fountain</option>
<option value="Frankfort">Frankfort</option>
<option value="Franklin">Franklin</option>
<option value="Franklin City">Franklin City</option>
<option value="Frederick">Frederick</option>
<option value="Freeborn">Freeborn</option>
<option value="Freestone">Freestone</option>
<option value="Fremont">Fremont</option>
<option value="Fresno">Fresno</option>
<option value="Fulton">Fulton</option>
<option value="Furnas">Furnas</option>
<option value="Gadsden">Gadsden</option>
<option value="Gage">Gage</option>
<option value="Galax City">Galax City</option>
<option value="Gallatin">Gallatin</option>
<option value="Gallia">Gallia</option>
<option value="Galveston">Galveston</option>
<option value="Garfield">Garfield</option>
<option value="Garland">Garland</option>
<option value="Garrard">Garrard</option>
<option value="Garrett">Garrett</option>
<option value="Gasconade">Gasconade</option>
<option value="Gaston">Gaston</option>
<option value="Geary">Geary</option>
<option value="Geauga">Geauga</option>
<option value="Genesee">Genesee</option>
<option value="Geneva">Geneva</option>
<option value="Georgetown">Georgetown</option>
<option value="Gibson">Gibson</option>
<option value="Gila">Gila</option>
<option value="Giles">Giles</option>
<option value="Gillespie">Gillespie</option>
<option value="Gilmer">Gilmer</option>
<option value="Gilpin">Gilpin</option>
<option value="Glacier">Glacier</option>
<option value="Glades">Glades</option>
<option value="Gladwin">Gladwin</option>
<option value="Glasgow">Glasgow</option>
<option value="Glasscock">Glasscock</option>
<option value="Gloucester">Gloucester</option>
<option value="Glynn">Glynn</option>
<option value="Gogebic">Gogebic</option>
<option value="Goochland">Goochland</option>
<option value="Goodhue">Goodhue</option>
<option value="Gordon">Gordon</option>
<option value="Grady">Grady</option>
<option value="Grafton">Grafton</option>
<option value="Graham">Graham</option>
<option value="Grainger">Grainger</option>
<option value="Grand Forks">Grand Forks</option>
<option value="Grand Traverse">Grand Traverse</option>
<option value="Granite">Granite</option>
<option value="Grant">Grant</option>
<option value="Granville">Granville</option>
<option value="Gratiot">Gratiot</option>
<option value="Graves">Graves</option>
<option value="Gray">Gray</option>
<option value="Grays Harbor">Grays Harbor</option>
<option value="Grayson">Grayson</option>
<option value="Green">Green</option>
<option value="Greenbrier">Greenbrier</option>
<option value="Greene">Greene</option>
<option value="Greenup">Greenup</option>
<option value="Greenville">Greenville</option>
<option value="Greenwood">Greenwood</option>
<option value="Gregg">Gregg</option>
<option value="Grenada">Grenada</option>
<option value="Grimes">Grimes</option>
<option value="Grundy">Grundy</option>
<option value="Guadalupe">Guadalupe</option>
<option value="Guam">Guam</option>
<option value="Guaynabo">Guaynabo</option>
<option value="Guernsey">Guernsey</option>
<option value="Guilford">Guilford</option>
<option value="Gulf">Gulf</option>
<option value="Gunnison">Gunnison</option>
<option value="Gwinnett">Gwinnett</option>
<option value="Haakon">Haakon</option>
<option value="Habersham">Habersham</option>
<option value="Hale">Hale</option>
<option value="Halifax">Halifax</option>
<option value="Hall">Hall</option>
<option value="Hamblen">Hamblen</option>
<option value="Hamilton">Hamilton</option>
<option value="Hampden">Hampden</option>
<option value="Hampshire">Hampshire</option>
<option value="Hampton">Hampton</option>
<option value="Hampton City">Hampton City</option>
<option value="Hancock">Hancock</option>
<option value="Hanover">Hanover</option>
<option value="Haralson">Haralson</option>
<option value="Hardee">Hardee</option>
<option value="Hardeman">Hardeman</option>
<option value="Hardin">Hardin</option>
<option value="Harford">Harford</option>
<option value="Harlan">Harlan</option>
<option value="Harnett">Harnett</option>
<option value="Harper">Harper</option>
<option value="Harris">Harris</option>
<option value="Harrison">Harrison</option>
<option value="Harrisonburg City">Harrisonburg City</option>
<option value="Hart">Hart</option>
<option value="Hartford">Hartford</option>
<option value="Harvey">Harvey</option>
<option value="Hawaii">Hawaii</option>
<option value="Hawkins">Hawkins</option>
<option value="Hays">Hays</option>
<option value="Haywood">Haywood</option>
<option value="Henderson">Henderson</option>
<option value="Hendricks">Hendricks</option>
<option value="Hendry">Hendry</option>
<option value="Hennepin">Hennepin</option>
<option value="Henrhy">Henrhy</option>
<option value="Henrico">Henrico</option>
<option value="Henry">Henry</option>
<option value="Herkimer">Herkimer</option>
<option value="Hernando">Hernando</option>
<option value="Hertford">Hertford</option>
<option value="Hickman">Hickman</option>
<option value="Hidalgo">Hidalgo</option>
<option value="Highland">Highland</option>
<option value="Highlands">Highlands</option>
<option value="Hillsborough">Hillsborough</option>
<option value="Hillsdale">Hillsdale</option>
<option value="Hinds">Hinds</option>
<option value="Hocking">Hocking</option>
<option value="Hoke">Hoke</option>
<option value="Holmes">Holmes</option>
<option value="Honolulu">Honolulu</option>
<option value="Hood">Hood</option>
<option value="Hopewell City">Hopewell City</option>
<option value="Hopkins">Hopkins</option>
<option value="Horry">Horry</option>
<option value="Hot Spring">Hot Spring</option>
<option value="Hot Springs">Hot Springs</option>
<option value="Houghton">Houghton</option>
<option value="Houston">Houston</option>
<option value="Howard">Howard</option>
<option value="Howell">Howell</option>
<option value="Hubbard">Hubbard</option>
<option value="Hudson">Hudson</option>
<option value="Humboldt">Humboldt</option>
<option value="Humphreys">Humphreys</option>
<option value="Hunt">Hunt</option>
<option value="Hunterdon">Hunterdon</option>
<option value="Huntingdon">Huntingdon</option>
<option value="Huntington">Huntington</option>
<option value="Huron">Huron</option>
<option value="Hyde">Hyde</option>
<option value="Iberia">Iberia</option>
<option value="Independence">Independence</option>
<option value="Indian River">Indian River</option>
<option value="Indiana">Indiana</option>
<option value="Ingham">Ingham</option>
<option value="Inyo">Inyo</option>
<option value="Ionia">Ionia</option>
<option value="Iosco">Iosco</option>
<option value="Iowa">Iowa</option>
<option value="Iredell">Iredell</option>
<option value="Iron">Iron</option>
<option value="Iroquois">Iroquois</option>
<option value="Isabella">Isabella</option>
<option value="Isanti">Isanti</option>
<option value="Island">Island</option>
<option value="Itasca">Itasca</option>
<option value="Itawamba">Itawamba</option>
<option value="Izard">Izard</option>
<option value="Jack">Jack</option>
<option value="Jackson">Jackson</option>
<option value="James City">James City</option>
<option value="Jasper">Jasper</option>
<option value="Jay">Jay</option>
<option value="Jefferson">Jefferson</option>
<option value="Jefferson Davis">Jefferson Davis</option>
<option value="Jennings">Jennings</option>
<option value="Jessamine">Jessamine</option>
<option value="Jo Daviess">Jo Daviess</option>
<option value="Johnson">Johnson</option>
<option value="Johnston">Johnston</option>
<option value="Jones">Jones</option>
<option value="Juneau">Juneau</option>
<option value="Kalamazoo">Kalamazoo</option>
<option value="Kalkaska">Kalkaska</option>
<option value="Kanabec">Kanabec</option>
<option value="Kanawha">Kanawha</option>
<option value="Kandiyohi">Kandiyohi</option>
<option value="Kane">Kane</option>
<option value="Kankakee">Kankakee</option>
<option value="Karnes">Karnes</option>
<option value="Kauai">Kauai</option>
<option value="Kaufman">Kaufman</option>
<option value="Kay">Kay</option>
<option value="Kenai Peninsula">Kenai Peninsula</option>
<option value="Kendall">Kendall</option>
<option value="Kennebec">Kennebec</option>
<option value="Kenosha">Kenosha</option>
<option value="Kent">Kent</option>
<option value="Kenton">Kenton</option>
<option value="Kern">Kern</option>
<option value="Kerr">Kerr</option>
<option value="Kershaw">Kershaw</option>
<option value="Ketchikan Gateway">Ketchikan Gateway</option>
<option value="King">King</option>
<option value="King George">King George</option>
<option value="Kings">Kings</option>
<option value="Kiowa">Kiowa</option>
<option value="Kitsap">Kitsap</option>
<option value="Klamath">Klamath</option>
<option value="Kleberg">Kleberg</option>
<option value="Klickitat">Klickitat</option>
<option value="Knott">Knott</option>
<option value="Knox">Knox</option>
<option value="Kodiak Island">Kodiak Island</option>
<option value="Koochiching">Koochiching</option>
<option value="Kootenai">Kootenai</option>
<option value="Kosciusko">Kosciusko</option>
<option value="La Crosse">La Crosse</option>
<option value="La Plata">La Plata</option>
<option value="La Porte">La Porte</option>
<option value="La Salle">La Salle</option>
<option value="Labette">Labette</option>
<option value="Lackawanna">Lackawanna</option>
<option value="Laclede">Laclede</option>
<option value="Lafayette">Lafayette</option>
<option value="Lafourche">Lafourche</option>
<option value="Lagrange">Lagrange</option>
<option value="Lake">Lake</option>
<option value="Lamar">Lamar</option>
<option value="Lamb">Lamb</option>
<option value="Lampasas">Lampasas</option>
<option value="Lancaster">Lancaster</option>
<option value="Lane">Lane</option>
<option value="Langlade">Langlade</option>
<option value="Lapeer">Lapeer</option>
<option value="LaPorte">LaPorte</option>
<option value="Laramie">Laramie</option>
<option value="Larimer">Larimer</option>
<option value="LaRue">LaRue</option>
<option value="Lassen">Lassen</option>
<option value="Latah">Latah</option>
<option value="Lauderdale">Lauderdale</option>
<option value="Laurel">Laurel</option>
<option value="Laurens">Laurens</option>
<option value="Lawrence">Lawrence</option>
<option value="Le Sueur">Le Sueur</option>
<option value="Leavenworth">Leavenworth</option>
<option value="Lebanon">Lebanon</option>
<option value="Lee">Lee</option>
<option value="Leelanau">Leelanau</option>
<option value="Leflore">Leflore</option>
<option value="Lehigh">Lehigh</option>
<option value="Lenawee">Lenawee</option>
<option value="Lenoir">Lenoir</option>
<option value="Leon">Leon</option>
<option value="Leslie">Leslie</option>
<option value="Letcher">Letcher</option>
<option value="Levy">Levy</option>
<option value="Lewis">Lewis</option>
<option value="Lewis and Clark">Lewis and Clark</option>
<option value="Lexington">Lexington</option>
<option value="Lexington City">Lexington City</option>
<option value="Liberty">Liberty</option>
<option value="Licking">Licking</option>
<option value="Limestone">Limestone</option>
<option value="Lincoln">Lincoln</option>
<option value="Linn">Linn</option>
<option value="Lipscomb">Lipscomb</option>
<option value="Litchfield">Litchfield</option>
<option value="Live Oak">Live Oak</option>
<option value="Livingston">Livingston</option>
<option value="Logan">Logan</option>
<option value="Long">Long</option>
<option value="Lonoke">Lonoke</option>
<option value="Lorain">Lorain</option>
<option value="Los Angeles">Los Angeles</option>
<option value="Loudon">Loudon</option>
<option value="Loudoun">Loudoun</option>
<option value="Louisa">Louisa</option>
<option value="Lowndes">Lowndes</option>
<option value="Lubbock">Lubbock</option>
<option value="Lucas">Lucas</option>
<option value="Lumpkin">Lumpkin</option>
<option value="Lunenburg">Lunenburg</option>
<option value="Luzerne">Luzerne</option>
<option value="Lycoming">Lycoming</option>
<option value="Lynchburg City">Lynchburg City</option>
<option value="Lyon">Lyon</option>
<option value="Lyons">Lyons</option>
<option value="Mackinac">Mackinac</option>
<option value="Macomb">Macomb</option>
<option value="Macon">Macon</option>
<option value="Macoupin">Macoupin</option>
<option value="Madison">Madison</option>
<option value="Magoffin">Magoffin</option>
<option value="Mahaska">Mahaska</option>
<option value="Mahoning">Mahoning</option>
<option value="Manassas City">Manassas City</option>
<option value="Manassas Park City">Manassas Park City</option>
<option value="Manatee">Manatee</option>
<option value="Manchester">Manchester</option>
<option value="Manistee">Manistee</option>
<option value="Manitowoc">Manitowoc</option>
<option value="Marathon">Marathon</option>
<option value="Maricopa">Maricopa</option>
<option value="Marin">Marin</option>
<option value="Marion">Marion</option>
<option value="Mariposa">Mariposa</option>
<option value="Marlboro">Marlboro</option>
<option value="Marquette">Marquette</option>
<option value="Marshall">Marshall</option>
<option value="Martin">Martin</option>
<option value="Martinsville City">Martinsville City</option>
<option value="Mason">Mason</option>
<option value="Massac">Massac</option>
<option value="Matanuska Susitna">Matanuska Susitna</option>
<option value="Mathews">Mathews</option>
<option value="Maui">Maui</option>
<option value="Maury">Maury</option>
<option value="Mayaguez">Mayaguez</option>
<option value="Mayes">Mayes</option>
<option value="McCormick">McCormick</option>
<option value="McCracken">McCracken</option>
<option value="McCreary">McCreary</option>
<option value="McDonough">McDonough</option>
<option value="McDowell">McDowell</option>
<option value="McDuffie">McDuffie</option>
<option value="McHenry">McHenry</option>
<option value="McKean">McKean</option>
<option value="McKenzie">McKenzie</option>
<option value="McKinley">McKinley</option>
<option value="McLean">McLean</option>
<option value="McLennan">McLennan</option>
<option value="McLeod">McLeod</option>
<option value="McLeran">McLeran</option>
<option value="McMinn">McMinn</option>
<option value="McNairy">McNairy</option>
<option value="Mead">Mead</option>
<option value="Meade">Meade</option>
<option value="Mecklenburg">Mecklenburg</option>
<option value="Mecosta">Mecosta</option>
<option value="Medina">Medina</option>
<option value="Meeker">Meeker</option>
<option value="Meigs">Meigs</option>
<option value="Menard">Menard</option>
<option value="Mendocino">Mendocino</option>
<option value="Menifee">Menifee</option>
<option value="Merced">Merced</option>
<option value="Mercer">Mercer</option>
<option value="Meriwether">Meriwether</option>
<option value="Merrick">Merrick</option>
<option value="Merrimack">Merrimack</option>
<option value="Mesa">Mesa</option>
<option value="Metcalfe">Metcalfe</option>
<option value="Miami">Miami</option>
<option value="Miami-Dade">Miami-Dade</option>
<option value="Middlesex">Middlesex</option>
<option value="Midland">Midland</option>
<option value="Millard">Millard</option>
<option value="Mille Lacs">Mille Lacs</option>
<option value="Miller">Miller</option>
<option value="Milwaukee">Milwaukee</option>
<option value="Mineral">Mineral</option>
<option value="Mingo">Mingo</option>
<option value="Minnehaha">Minnehaha</option>
<option value="Missaukee">Missaukee</option>
<option value="Mississippi">Mississippi</option>
<option value="Missoula">Missoula</option>
<option value="Mitchell">Mitchell</option>
<option value="Mobile">Mobile</option>
<option value="Moffat">Moffat</option>
<option value="Mohave">Mohave</option>
<option value="Monmouth">Monmouth</option>
<option value="Monona">Monona</option>
<option value="Monongalia">Monongalia</option>
<option value="Monroe">Monroe</option>
<option value="Montcalm">Montcalm</option>
<option value="Monterey">Monterey</option>
<option value="Montgomery">Montgomery</option>
<option value="Montour">Montour</option>
<option value="Montrose">Montrose</option>
<option value="Moore">Moore</option>
<option value="Morehouse">Morehouse</option>
<option value="Morgan">Morgan</option>
<option value="Morris">Morris</option>
<option value="Morrow">Morrow</option>
<option value="Morton">Morton</option>
<option value="Moultrie">Moultrie</option>
<option value="Mower">Mower</option>
<option value="Muhlenberg">Muhlenberg</option>
<option value="Muhlenburg">Muhlenburg</option>
<option value="Multnomah">Multnomah</option>
<option value="Murray">Murray</option>
<option value="Muscatine">Muscatine</option>
<option value="Muscogee">Muscogee</option>
<option value="Muskegon">Muskegon</option>
<option value="Muskingum">Muskingum</option>
<option value="Muskogee">Muskogee</option>
<option value="Nacogdoches">Nacogdoches</option>
<option value="Nantucket">Nantucket</option>
<option value="Napa">Napa</option>
<option value="Nash">Nash</option>
<option value="Nassau">Nassau</option>
<option value="Natchitoches">Natchitoches</option>
<option value="Natrona">Natrona</option>
<option value="Navarro">Navarro</option>
<option value="Nelson">Nelson</option>
<option value="Neshoba">Neshoba</option>
<option value="Nevada">Nevada</option>
<option value="New Castle">New Castle</option>
<option value="New Hanover">New Hanover</option>
<option value="New Haven">New Haven</option>
<option value="New Kent">New Kent</option>
<option value="New London">New London</option>
<option value="New Madrid">New Madrid</option>
<option value="New York">New York</option>
<option value="Newaygo">Newaygo</option>
<option value="Newberry">Newberry</option>
<option value="Newport">Newport</option>
<option value="Newport News City">Newport News City</option>
<option value="Newton">Newton</option>
<option value="Nez Perce">Nez Perce</option>
<option value="Niagara">Niagara</option>
<option value="Nicholas">Nicholas</option>
<option value="Nicollet">Nicollet</option>
<option value="Noble">Noble</option>
<option value="Nobles">Nobles</option>
<option value="Nodaway">Nodaway</option>
<option value="Nome">Nome</option>
<option value="Norfolk">Norfolk</option>
<option value="Norfolk City">Norfolk City</option>
<option value="Northampton">Northampton</option>
<option value="Northumberland">Northumberland</option>
<option value="Nueces">Nueces</option>
<option value="Nye">Nye</option>
<option value="Oakland">Oakland</option>
<option value="Obion">Obion</option>
<option value="Ocean">Ocean</option>
<option value="Oceana">Oceana</option>
<option value="Oconee">Oconee</option>
<option value="Oconto">Oconto</option>
<option value="Ogemaw">Ogemaw</option>
<option value="Ogle">Ogle</option>
<option value="Oglethorpe">Oglethorpe</option>
<option value="Ohio">Ohio</option>
<option value="Okaloosa">Okaloosa</option>
<option value="Okeechobee">Okeechobee</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Okmulgee">Okmulgee</option>
<option value="Oktibbeha">Oktibbeha</option>
<option value="Oldham">Oldham</option>
<option value="Olmsted">Olmsted</option>
<option value="Oneida">Oneida</option>
<option value="Onondaga">Onondaga</option>
<option value="Onslow">Onslow</option>
<option value="Ontario">Ontario</option>
<option value="Orange">Orange</option>
<option value="Orangeburg">Orangeburg</option>
<option value="Oregon">Oregon</option>
<option value="Orleans">Orleans</option>
<option value="Osage">Osage</option>
<option value="Osceola">Osceola</option>
<option value="Oscoda">Oscoda</option>
<option value="Oswego">Oswego</option>
<option value="Otero">Otero</option>
<option value="Otoe">Otoe</option>
<option value="Otsego">Otsego</option>
<option value="Ottawa">Ottawa</option>
<option value="Otter Tail">Otter Tail</option>
<option value="Ouachita">Ouachita</option>
<option value="Outagamie">Outagamie</option>
<option value="Overton">Overton</option>
<option value="Owen">Owen</option>
<option value="Owsley">Owsley</option>
<option value="Ozark">Ozark</option>
<option value="Ozaukee">Ozaukee</option>
<option value="Pacific">Pacific</option>
<option value="Page">Page</option>
<option value="Palm Beach">Palm Beach</option>
<option value="Pamlico">Pamlico</option>
<option value="Panola">Panola</option>
<option value="Park">Park</option>
<option value="Parker">Parker</option>
<option value="Parmer">Parmer</option>
<option value="Pasco">Pasco</option>
<option value="Pasquotank">Pasquotank</option>
<option value="Passaic">Passaic</option>
<option value="Paulding">Paulding</option>
<option value="Pawnee">Pawnee</option>
<option value="Payette">Payette</option>
<option value="Payne">Payne</option>
<option value="Peach">Peach</option>
<option value="Pearl River">Pearl River</option>
<option value="Pender">Pender</option>
<option value="Pendleton">Pendleton</option>
<option value="Pennington">Pennington</option>
<option value="Penobscot">Penobscot</option>
<option value="Peoria">Peoria</option>
<option value="Perquimans">Perquimans</option>
<option value="Perry">Perry</option>
<option value="Person">Person</option>
<option value="Petersburg City">Petersburg City</option>
<option value="Pettis">Pettis</option>
<option value="Phelps">Phelps</option>
<option value="Philadelphia">Philadelphia</option>
<option value="Phillips">Phillips</option>
<option value="Piatt">Piatt</option>
<option value="Pickaway">Pickaway</option>
<option value="Pickens">Pickens</option>
<option value="Pickett">Pickett</option>
<option value="Pierce">Pierce</option>
<option value="Pike">Pike</option>
<option value="Pima">Pima</option>
<option value="Pinal">Pinal</option>
<option value="Pinellas">Pinellas</option>
<option value="Pipestone">Pipestone</option>
<option value="Pitkin">Pitkin</option>
<option value="Pitt">Pitt</option>
<option value="Pittsburg">Pittsburg</option>
<option value="Pittsylvania">Pittsylvania</option>
<option value="Placer">Placer</option>
<option value="Plaquemines">Plaquemines</option>
<option value="Platte">Platte</option>
<option value="Plumas">Plumas</option>
<option value="Plymouth">Plymouth</option>
<option value="Polk">Polk</option>
<option value="Pontotoc">Pontotoc</option>
<option value="Pope">Pope</option>
<option value="Poquoson City">Poquoson City</option>
<option value="Portage">Portage</option>
<option value="Porter">Porter</option>
<option value="Portsmouth City">Portsmouth City</option>
<option value="Posey">Posey</option>
<option value="Pottawatomie">Pottawatomie</option>
<option value="Pottawattamie">Pottawattamie</option>
<option value="Potter">Potter</option>
<option value="Powell">Powell</option>
<option value="Poweshiek">Poweshiek</option>
<option value="Powhatan">Powhatan</option>
<option value="Preble">Preble</option>
<option value="Prentiss">Prentiss</option>
<option value="Presque Isle">Presque Isle</option>
<option value="Prince Edward">Prince Edward</option>
<option value="Prince George">Prince George</option>
<option value="Prince Georges">Prince Georges</option>
<option value="Prince William">Prince William</option>
<option value="Providence">Providence</option>
<option value="Pueblo">Pueblo</option>
<option value="Pulaski">Pulaski</option>
<option value="Putnam">Putnam</option>
<option value="Queen Annes">Queen Annes</option>
<option value="Queens">Queens</option>
<option value="Rabun">Rabun</option>
<option value="Racine">Racine</option>
<option value="Radford">Radford</option>
<option value="Raleigh">Raleigh</option>
<option value="Ramsey">Ramsey</option>
<option value="Randall">Randall</option>
<option value="Randolph">Randolph</option>
<option value="Rankin">Rankin</option>
<option value="Rapides">Rapides</option>
<option value="Rappahannock">Rappahannock</option>
<option value="Ravalli">Ravalli</option>
<option value="Ray">Ray</option>
<option value="Red River">Red River</option>
<option value="Redwood">Redwood</option>
<option value="Reno">Reno</option>
<option value="Rensselaer">Rensselaer</option>
<option value="Renville">Renville</option>
<option value="Rhea">Rhea</option>
<option value="Rice">Rice</option>
<option value="Richland">Richland</option>
<option value="Richmond">Richmond</option>
<option value="Richmond City">Richmond City</option>
<option value="Riley">Riley</option>
<option value="Rio Arriba">Rio Arriba</option>
<option value="Ripley">Ripley</option>
<option value="Riverside">Riverside</option>
<option value="Roane">Roane</option>
<option value="Roanoke">Roanoke</option>
<option value="Roanoke City">Roanoke City</option>
<option value="Robertson">Robertson</option>
<option value="Robeson">Robeson</option>
<option value="Rock">Rock</option>
<option value="Rock Island">Rock Island</option>
<option value="Rockbridge">Rockbridge</option>
<option value="Rockcastle">Rockcastle</option>
<option value="Rockdale">Rockdale</option>
<option value="Rockingham">Rockingham</option>
<option value="Rockland">Rockland</option>
<option value="Rockwall">Rockwall</option>
<option value="Rogers">Rogers</option>
<option value="Roosevelt">Roosevelt</option>
<option value="Roscommon">Roscommon</option>
<option value="Ross">Ross</option>
<option value="Routt">Routt</option>
<option value="Rowan">Rowan</option>
<option value="Rush">Rush</option>
<option value="Rusk">Rusk</option>
<option value="Russell">Russell</option>
<option value="Rutherford">Rutherford</option>
<option value="Rutland">Rutland</option>
<option value="Sabine">Sabine</option>
<option value="Sacramento">Sacramento</option>
<option value="Sagadahoc">Sagadahoc</option>
<option value="Saginaw">Saginaw</option>
<option value="Saint Charles">Saint Charles</option>
<option value="Saint Clair">Saint Clair</option>
<option value="Saint Croix">Saint Croix</option>
<option value="Saint Francois">Saint Francois</option>
<option value="Saint Johns">Saint Johns</option>
<option value="Saint Joseph">Saint Joseph</option>
<option value="Saint Landry">Saint Landry</option>
<option value="Saint Lawrence">Saint Lawrence</option>
<option value="Saint Louis">Saint Louis</option>
<option value="Saint Louis city">Saint Louis city</option>
<option value="Saint Lucie">Saint Lucie</option>
<option value="Saint Mary">Saint Mary</option>
<option value="Saint Marys">Saint Marys</option>
<option value="Saint Tammany">Saint Tammany</option>
<option value="Saint Thomas">Saint Thomas</option>
<option value="Sainte Genevieve">Sainte Genevieve</option>
<option value="Salem">Salem</option>
<option value="Saline">Saline</option>
<option value="Salt Lake">Salt Lake</option>
<option value="Saluda">Saluda</option>
<option value="Sampson">Sampson</option>
<option value="San Bernardino">San Bernardino</option>
<option value="San Diego">San Diego</option>
<option value="San Francisco">San Francisco</option>
<option value="San German">San German</option>
<option value="San Joaquin">San Joaquin</option>
<option value="San Juan">San Juan</option>
<option value="San Luis Obispo">San Luis Obispo</option>
<option value="San Mateo">San Mateo</option>
<option value="San Miguel">San Miguel</option>
<option value="San Patricio">San Patricio</option>
<option value="Sandoval">Sandoval</option>
<option value="Sandusky">Sandusky</option>
<option value="Sangamon">Sangamon</option>
<option value="Sanilac">Sanilac</option>
<option value="Santa Barbara">Santa Barbara</option>
<option value="Santa Clara">Santa Clara</option>
<option value="Santa Cruz">Santa Cruz</option>
<option value="Santa Fe">Santa Fe</option>
<option value="Santa Rosa">Santa Rosa</option>
<option value="Sarasota">Sarasota</option>
<option value="Saratoga">Saratoga</option>
<option value="Sarpy">Sarpy</option>
<option value="Sauk">Sauk</option>
<option value="Saunders">Saunders</option>
<option value="Sawyer">Sawyer</option>
<option value="Schenectady">Schenectady</option>
<option value="Schuyler">Schuyler</option>
<option value="Schuylkill">Schuylkill</option>
<option value="Scioto">Scioto</option>
<option value="Scotland">Scotland</option>
<option value="Scott">Scott</option>
<option value="Sebastian">Sebastian</option>
<option value="Sedgwick">Sedgwick</option>
<option value="Seminole">Seminole</option>
<option value="Seneca">Seneca</option>
<option value="Sequatchie">Sequatchie</option>
<option value="Sequoyah">Sequoyah</option>
<option value="Sevier">Sevier</option>
<option value="Shasta">Shasta</option>
<option value="Shawano">Shawano</option>
<option value="Shawnee">Shawnee</option>
<option value="Sheboygan">Sheboygan</option>
<option value="Shelby">Shelby</option>
<option value="Shelbyville">Shelbyville</option>
<option value="Shenandoah">Shenandoah</option>
<option value="Sherburne">Sherburne</option>
<option value="Sheridan">Sheridan</option>
<option value="Sherman">Sherman</option>
<option value="Shiawassee">Shiawassee</option>
<option value="Silver Bow">Silver Bow</option>
<option value="Simpson">Simpson</option>
<option value="Sioux">Sioux</option>
<option value="Siskiyou">Siskiyou</option>
<option value="Sitka">Sitka</option>
<option value="Skagit">Skagit</option>
<option value="Skamania">Skamania</option>
<option value="Smith">Smith</option>
<option value="Smyth">Smyth</option>
<option value="Snohomish">Snohomish</option>
<option value="Snyder">Snyder</option>
<option value="Solano">Solano</option>
<option value="Somerset">Somerset</option>
<option value="Sonoma">Sonoma</option>
<option value="Southampton">Southampton</option>
<option value="Spalding">Spalding</option>
<option value="Spartanburg">Spartanburg</option>
<option value="Spencer">Spencer</option>
<option value="Spokane">Spokane</option>
<option value="Spotsylvania">Spotsylvania</option>
<option value="St John the Baptist">St John the Baptist</option>
<option value="St Joseph">St Joseph</option>
<option value="Stafford">Stafford</option>
<option value="Stanislaus">Stanislaus</option>
<option value="Stanley">Stanley</option>
<option value="Stanly">Stanly</option>
<option value="Stanton">Stanton</option>
<option value="Stark">Stark</option>
<option value="Starke">Starke</option>
<option value="Staunton City">Staunton City</option>
<option value="Stearns">Stearns</option>
<option value="Stephens">Stephens</option>
<option value="Stephenson">Stephenson</option>
<option value="Steuben">Steuben</option>
<option value="Stewart">Stewart</option>
<option value="Stoddard">Stoddard</option>
<option value="Stokes">Stokes</option>
<option value="Stone">Stone</option>
<option value="Story">Story</option>
<option value="Strafford">Strafford</option>
<option value="Sublette">Sublette</option>
<option value="Suffolk">Suffolk</option>
<option value="Suffolk City">Suffolk City</option>
<option value="Sullivan">Sullivan</option>
<option value="Summers">Summers</option>
<option value="Summit">Summit</option>
<option value="Sumner">Sumner</option>
<option value="Sumter">Sumter</option>
<option value="Surry">Surry</option>
<option value="Susquehanna">Susquehanna</option>
<option value="Sussex">Sussex</option>
<option value="Suwannee">Suwannee</option>
<option value="Sweetwater">Sweetwater</option>
<option value="Switzerland">Switzerland</option>
<option value="Talbot">Talbot</option>
<option value="Talladega">Talladega</option>
<option value="Tallapoosa">Tallapoosa</option>
<option value="Taney">Taney</option>
<option value="Tangipahoa">Tangipahoa</option>
<option value="Tarrant">Tarrant</option>
<option value="Tate">Tate</option>
<option value="Taylor">Taylor</option>
<option value="Tazewell">Tazewell</option>
<option value="Tehama">Tehama</option>
<option value="Teller">Teller</option>
<option value="Terrebonne">Terrebonne</option>
<option value="Terrell">Terrell</option>
<option value="Teton">Teton</option>
<option value="Thomas">Thomas</option>
<option value="Thurston">Thurston</option>
<option value="Tift">Tift</option>
<option value="Tillamook">Tillamook</option>
<option value="Tioga">Tioga</option>
<option value="Tippecanoe">Tippecanoe</option>
<option value="Tipton">Tipton</option>
<option value="Tishomingo">Tishomingo</option>
<option value="Todd">Todd</option>
<option value="Tolland">Tolland</option>
<option value="Tompkins">Tompkins</option>
<option value="Tooele">Tooele</option>
<option value="Torrance">Torrance</option>
<option value="Towns">Towns</option>
<option value="Transylvania">Transylvania</option>
<option value="Travis">Travis</option>
<option value="Trigg">Trigg</option>
<option value="Trimble">Trimble</option>
<option value="Troup">Troup</option>
<option value="Trousdale">Trousdale</option>
<option value="Trumbull">Trumbull</option>
<option value="Tulare">Tulare</option>
<option value="Tulsa">Tulsa</option>
<option value="Tuolumne">Tuolumne</option>
<option value="Tuscaloosa">Tuscaloosa</option>
<option value="Tuscarawas">Tuscarawas</option>
<option value="Twin Falls">Twin Falls</option>
<option value="Tyler">Tyler</option>
<option value="Uinta">Uinta</option>
<option value="Uintah">Uintah</option>
<option value="Ulster">Ulster</option>
<option value="Umatilla">Umatilla</option>
<option value="Unicoi">Unicoi</option>
<option value="Union">Union</option>
<option value="Unknown">Unknown</option>
<option value="Utah">Utah</option>
<option value="Uvalde">Uvalde</option>
<option value="Val Verde">Val Verde</option>
<option value="Valencia">Valencia</option>
<option value="Valley">Valley</option>
<option value="Van Buren">Van Buren</option>
<option value="Van Wert">Van Wert</option>
<option value="Vance">Vance</option>
<option value="Vandeburgh">Vandeburgh</option>
<option value="Vandenburg">Vandenburg</option>
<option value="Vanderburg">Vanderburg</option>
<option value="Vanderburgh">Vanderburgh</option>
<option value="Vega Baja">Vega Baja</option>
<option value="Venango">Venango</option>
<option value="Ventura">Ventura</option>
<option value="Vermilion">Vermilion</option>
<option value="Vermillion">Vermillion</option>
<option value="Vernon">Vernon</option>
<option value="Victoria">Victoria</option>
<option value="Vigo">Vigo</option>
<option value="Vilas">Vilas</option>
<option value="Virginia Beach City">Virginia Beach City</option>
<option value="Volusia">Volusia</option>
<option value="Wabash">Wabash</option>
<option value="Wabasha">Wabasha</option>
<option value="Wadena">Wadena</option>
<option value="Wagoner">Wagoner</option>
<option value="Wake">Wake</option>
<option value="Wakulla">Wakulla</option>
<option value="Waldo">Waldo</option>
<option value="Walker">Walker</option>
<option value="Waller">Waller</option>
<option value="Wallowa">Wallowa</option>
<option value="Walton">Walton</option>
<option value="Walworth">Walworth</option>
<option value="Wapello">Wapello</option>
<option value="Ward">Ward</option>
<option value="Warren">Warren</option>
<option value="Warrick">Warrick</option>
<option value="Wasatch">Wasatch</option>
<option value="Wasco">Wasco</option>
<option value="Waseca">Waseca</option>
<option value="Washakie">Washakie</option>
<option value="Washburn">Washburn</option>
<option value="Washington">Washington</option>
<option value="Washoe">Washoe</option>
<option value="Washtenaw">Washtenaw</option>
<option value="Watauga">Watauga</option>
<option value="Waukesha">Waukesha</option>
<option value="Waupaca">Waupaca</option>
<option value="Waushara">Waushara</option>
<option value="Wayne">Wayne</option>
<option value="Waynesboro City">Waynesboro City</option>
<option value="Weakley">Weakley</option>
<option value="Webb">Webb</option>
<option value="Weber">Weber</option>
<option value="Webster">Webster</option>
<option value="Weld">Weld</option>
<option value="Wells">Wells</option>
<option value="West Baton Rouge">West Baton Rouge</option>
<option value="West Feliciana">West Feliciana</option>
<option value="Westchester">Westchester</option>
<option value="Westmoreland">Westmoreland</option>
<option value="Wetzel">Wetzel</option>
<option value="Wexford">Wexford</option>
<option value="Whatcom">Whatcom</option>
<option value="Wheeler">Wheeler</option>
<option value="White">White</option>
<option value="Whiteside">Whiteside</option>
<option value="Whitfield">Whitfield</option>
<option value="Whitley">Whitley</option>
<option value="Wichita">Wichita</option>
<option value="Wicomico">Wicomico</option>
<option value="Wilcox">Wilcox</option>
<option value="Wilkes">Wilkes</option>
<option value="Will">Will</option>
<option value="Williams">Williams</option>
<option value="Williamsburg City">Williamsburg City</option>
<option value="Williamson">Williamson</option>
<option value="Wilson">Wilson</option>
<option value="Winchester City">Winchester City</option>
<option value="Windham">Windham</option>
<option value="Windsor">Windsor</option>
<option value="Winkler">Winkler</option>
<option value="Winnebago">Winnebago</option>
<option value="Winneshiek">Winneshiek</option>
<option value="Winona">Winona</option>
<option value="Wise">Wise</option>
<option value="Wolfe">Wolfe</option>
<option value="Wood">Wood</option>
<option value="Woodbury">Woodbury</option>
<option value="Woodford">Woodford</option>
<option value="Woodward">Woodward</option>
<option value="Woodword">Woodword</option>
<option value="Worcester">Worcester</option>
<option value="Wright">Wright</option>
<option value="Wyandotte">Wyandotte</option>
<option value="Wyoming">Wyoming</option>
<option value="Wythe">Wythe</option>
<option value="Yadkin">Yadkin</option>
<option value="Yakima">Yakima</option>
<option value="Yamhill">Yamhill</option>
<option value="Yancey">Yancey</option>
<option value="Yankton">Yankton</option>
<option value="Yavapai">Yavapai</option>
<option value="Yazoo">Yazoo</option>
<option value="Yellowstone">Yellowstone</option>
<option value="Yolo">Yolo</option>
<option value="York">York</option>
<option value="Yuba">Yuba</option>
<option value="Yuma">Yuma</option>
</select>
</div>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="2" style="display: none;">
<label for="bboxdonation_billing_billingAddress_txtUKPostCode" id="bboxdonation_billing_billingAddress_lblUKPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">Postcode:</label>
<input name="bboxdonation$billing$billingAddress$txtUKPostCode" type="text" id="bboxdonation_billing_billingAddress_txtUKPostCode" class="BBFormTextbox" data-country-field="postcode" data-country-sync="1" required="required"
maxlength="12">
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="3" style="display: none;">
<label for="bboxdonation_billing_billingAddress_txtCACity" id="bboxdonation_billing_billingAddress_lblCACity" class="BBFormFieldLabel BBFormFieldLabelEdit">City:</label>
<input name="bboxdonation$billing$billingAddress$txtCACity" type="text" id="bboxdonation_billing_billingAddress_txtCACity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50">
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="3" style="display: none;">
<label for="bboxdonation_billing_billingAddress_ddCAProvince" id="bboxdonation_billing_billingAddress_lblCAProvincePostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">Province & postal:</label>
<div aria-describedby="bboxdonation_billing_billingAddress_ddCAProvince">
<span id="bboxdonation_billing_billingAddress_lblCAProvince" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Province:</span>
</div>
<select name="bboxdonation$billing$billingAddress$ddCAProvince" id="bboxdonation_billing_billingAddress_ddCAProvince" class="BBFormSelectList GhostText" data-country-sync="1" data-country-field="state" required="required">
<option selected="selected" value="" default="default">province</option>
<option value="Non">Non</option>
<option value="AA">AA</option>
<option value="AB">AB</option>
<option value="AE">AE</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AP">AP</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="BC">BC</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="CZ">CZ</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MB">MB</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NB">NB</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NL">NL</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NS">NS</option>
<option value="NT">NT</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="ON">ON</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PE">PE</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="QC">QC</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="SK">SK</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VI">VI</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="YT">YT</option>
<option value="NU">NU</option>
<option value="VIC">VIC</option>
</select>
<label for="bboxdonation_billing_billingAddress_txtCAPostCode" id="bboxdonation_billing_billingAddress_lblCAPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Postal:</label>
<input name="bboxdonation$billing$billingAddress$txtCAPostCode" type="text" id="bboxdonation_billing_billingAddress_txtCAPostCode" class="BBFormTextbox" required="required" data-country-sync="1" data-country-field="postcode"
maxlength="12" placeholder="postal">
</div>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="4" style="display: none;">
<label for="bboxdonation_billing_billingAddress_txtAUCity" id="bboxdonation_billing_billingAddress_lblAUCity" class="BBFormFieldLabel BBFormFieldLabelEdit">Suburb:</label>
<input name="bboxdonation$billing$billingAddress$txtAUCity" type="text" id="bboxdonation_billing_billingAddress_txtAUCity" class="BBFormTextbox" data-country-sync="1" data-country-field="city" required="required" maxlength="50">
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="4" style="display: none;">
<label for="bboxdonation_billing_billingAddress_ddAUState" id="bboxdonation_billing_billingAddress_lblAUStatePostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">State & postcode:</label>
<div aria-describedby="bboxdonation_billing_billingAddress_ddAUState">
<span id="bboxdonation_billing_billingAddress_lblAUState" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">State:</span>
</div>
<select name="bboxdonation$billing$billingAddress$ddAUState" id="bboxdonation_billing_billingAddress_ddAUState" class="BBFormSelectList GhostText" data-country-sync="1" data-country-field="state" required="required">
<option selected="selected" value="" default="default">state</option>
<option value="Non">Non</option>
<option value="AA">AA</option>
<option value="AB">AB</option>
<option value="AE">AE</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AP">AP</option>
<option value="AR">AR</option>
<option value="AS">AS</option>
<option value="AZ">AZ</option>
<option value="BC">BC</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="CZ">CZ</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="FM">FM</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MB">MB</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MH">MH</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MP">MP</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NB">NB</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NL">NL</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NS">NS</option>
<option value="NT">NT</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="ON">ON</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PE">PE</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
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HELP MAKE A DIFFERENCE HELP MAKE A DIFFERENCE * About Us * Wendy Novak’s Story * Our Team * Our Impact * Our Vision for the Future * Ready to Make a Difference CREATING HEALTHIER FUTURES FOR EVERYONE WITH DIABETES IMAGINE A WORLD WITHOUT DIABETES FOLLOWING THE VISION OF THE NOVAK FAMILY, WE’RE WORKING TO ACHIEVE WORLD-CLASS DIABETES CARE THROUGH A HOLISTIC AND COLLABORATIVE APPROACH. Diabetes can be a difficult disease to manage, regardless of age, and can impact your lifestyle. Through a coordinated and comprehensive approach, Wendy Novak Diabetes Institute provides care and management of diabetes during all stages of life through clinical services, education and research. The team with Norton Children’s Endocrinology, affiliated with the UofL School of Medicine, helps children and young adults up to age 26 – and their families. Through nationally recognized inpatient care at Jack and Wendy’s Place within Norton Children’s Hospital and outpatient care at the Novak Center for Children’s Health, we continue to reduce the negative impact diabetes has on children. Our team of specialists understands and emphasizes continuity of care, which is why we carefully plan and work with patients to seamlessly grow and move on to adult care. Adult outpatient services are offered through Norton Community Medical Associates – Endocrinology offices, and inpatient care is provided at four adult-service Norton Healthcare hospitals. With your help in supporting our educational outreach efforts, research innovation, workforce improvements, endowed chairs and life-changing clinical programs, we have the tools to empower our patients and their families while ensuring they live long, healthy and active lives with diabetes. Learn more about us -------------------------------------------------------------------------------- WITH 5 MILLION PEOPLE IN THE U.S. EXPECTED TO HAVE TYPE 1 DIABETES BY 2050, AND WITH KENTUCKY RANKED 7TH IN THE COUNTRY FOR DIABETES RATES, WE NEED YOUR HELP NOW MORE THAN EVER. -------------------------------------------------------------------------------- Make A Difference Hear David Novak and Ashley Novak Butler explain how the Wendy Novak Diabetes Institute is making a difference and how you can help. -------------------------------------------------------------------------------- 5,500+ Patient Visits Annually 30+ Diabetes Specialists 48 Health Care Presentations By Our Clinical Staff #23 A Top Pediatric Diabetes Program Ranked By U.S. News & World Report 10+ Diabetes Research Trials 3 Endocrinology Training Fellows -------------------------------------------------------------------------------- PATIENT SUCCESS STORIES Our interdisciplinary and collaborative approach to diabetes care empowers our patients to live long, healthy and active lives. The hope we instill in children is what drives us every day. NORAH PRICE At the tender age of four, Norah Price began to lose the upbeat personality to which her parents had become so accustomed. When Charles and Sarah Price learned their daughter had type 1 diabetes, it was a life-altering moment. Through the continued care and support received at the Wendy Novak Diabetes Institute, Norah has found reason to smile again. “She always remains positive, and she inspires us to be the same,” said Charles Price. Norah's Full Story DAVID ADAMS When David Adams was diagnosed with diabetes as an eighth-grade student, his life was turned upside down. Aspirations of following his father in the Marines were dashed because of his condition. It took some time, but with the support of his family, friends and the caregivers at Wendy Novak Diabetes Institute, he’s now empowered to live his best life. Recent technological advancements have also made his diabetes more easily managed, and have provided his mother, Beth, peace of mind. “I no longer constantly worry about his blood sugar levels as the device manages this for him,” she said. David's Full Story MASON CHRISTENSEN With help from his family and the team at Wendy Novak Diabetes Institute, Mason Christensen remains active in one of the things he loves most – playing sports. By empowering both Mason and his entire family with the education, training and support necessary to keep diabetes at bay, the Center has helped provide a sense of confidence to the Christensens to live life fully. “The special thing about the Center is that it’s not just focused on children; it’s an experience that involves the whole family,” said Mason’s father, Tony. Mason's Full Story WENDY NOVAK’S STORY WENDY NOVAK IS THE INSPIRATION FOR ALL WE’VE ACHIEVED AND FOR ALL WE’VE YET TO ACCOMPLISH. HER LIFE IS A TESTAMENT TO PERSEVERANCE IN THE FACE OF TYPE 1 DIABETES. Wendy's Story READY TO MAKE A DIFFERENCE? As our journey to world-class diabetes care continues, we welcome time, talent and treasure from people like you. Come join us on our journey where you can make a difference in a child’s life today. Donate Invest Volunteer Become an Ambassador Coordinate an Event Make a Difference OUR IMPACT Our team understands the challenges inherent in living with diabetes — many through personal experiences — and that empathetic perspective provides motivation to help our patients’ families thrive in the face of this disease. Here’s how we’re making a difference. Wendy Novak memoir on her diabetes journey offers hope, empowerment to others with the condition Read More Save 30% now on Diabetes and Me Read More Today Show visits Wendy Novak Diabetes Institute Read More View All WENDY NOVAK DIABETES INSTITUTE 411 E Chestnut Street, Level 7 Louisville, KY 40202 To make an appointment with Norton Children's Endocrinology, please call 502.588.3400. To learn more information about our services, please visit Norton Children’s Endocrinology. * About Us * Wendy Novak’s Story * Our Team * Our Impact * Our Vision for the Future * Ready to Make a Difference Enter your information below to sign up for our free Get Healthy Families e-mail newsletter. Once a week, you’ll receive stories and insights from the Norton Healthcare family, right in your inbox. 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