pretsa.pretsa-pass-us.com
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Submitted URL: https://pretsa.pretsa-pass-us.com/payment?coupon=SAVE15&utm_source=Abandon%20Checkout%20%2F%2F%204%20Emails&utm_medium=flow-email&...
Effective URL: https://pretsa.pretsa-pass-us.com/apply
Submission: On May 08 via manual from US — Scanned from US
Effective URL: https://pretsa.pretsa-pass-us.com/apply
Submission: On May 08 via manual from US — Scanned from US
Form analysis 1 forms found in the DOM
POST https://pretsa.pretsa-pass-us.com/apply
<form action="https://pretsa.pretsa-pass-us.com/apply" method="post" id="application-form">
<input type="hidden" name="_token" value="iT4KghBy84e2uswX0V8Oasr1qZ8g9O9lzfxoR5QI">
<div class="card">
<div class="card-header">
<h5 class="mb-0">Service Type</h5>
</div>
<div class="card-body">
<div class="form-group row mb-0">
<label for="type" class="col-sm-4 col-form-label">Select Service</label>
<div class="col-sm-8">
<select class="form-control" id="type" name="type">
<option value="0">TSA Pre-Check - New Application</option>
<option value="1">TSA Pre-Check - Renewal</option>
<option value="2">TSA Pre-Check - Child New Application (13+)</option>
<option value="3">TSA Pre-Check - Child Renewal (13+)</option>
</select>
</div>
</div>
<div class="form-group row ktn mt-3" style="display: none;">
<label for="ktn" class="col-sm-4 col-form-label pt-0">Known Traveler Number (KTN)</label>
<div class="col-sm-8">
<input type="text" class="form-control required" id="ktn" name="ktn" value="">
</div>
</div>
<div class="form-group row ktn" style="display: none;">
<label for="ktn-confirmation" class="col-sm-4 col-form-label">Confirm Known Traveler Number (KTN)</label>
<div class="col-sm-8">
<input type="text" class="form-control required" id="ktn-confirmation" name="ktn_confirmation" value="">
</div>
</div>
</div>
</div>
<div class="card mt-3">
<div class="card-header">
<h5 class="mb-0">Applicant's Basic Information</h5>
</div>
<div class="card-body">
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-4 col-form-label">Gender</legend>
<div class="col-sm-8">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="gender" id="gender-male" value="male" required="">
<label class="form-check-label" for="gender-male"> Male </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="gender" id="gender-female" value="female" required="">
<label class="form-check-label" for="gender-female"> Female </label>
</div>
</div>
</div>
</fieldset>
<div class="form-group row first-name">
<label for="first-name" class="col-sm-4 col-form-label">First Name</label>
<div class="col-sm-8">
<input type="text" class="form-control sp-chr-val" id="first-name" name="first_name" value="" required="">
</div>
</div>
<div class="form-group row middle-name">
<label for="middle-name" class="col-sm-4 col-form-label">Middle Name <span class="text-muted">(Optional)</span></label>
<div class="col-sm-8">
<input type="text" class="form-control sp-chr-val" id="middle-name" name="middle_name" value="">
</div>
</div>
<div class="form-group row last-name">
<label for="last-name" class="col-sm-4 col-form-label">Last Name</label>
<div class="col-sm-8">
<input type="text" class="form-control sp-chr-val" id="last-name" name="last_name" value="" required="">
</div>
</div>
<div class="form-group row">
<label for="suffix" class="col-sm-4 col-form-label">Suffix <span class="text-muted">(Optional)</span></label>
<div class="col-sm-8">
<select class="form-control" id="suffix" name="suffix">
<option value="" disabled="" selected="">Select one</option>
<option value="junior"> Junior </option>
<option value="senior"> Senior </option>
<option value="first"> First </option>
<option value="second"> Second </option>
<option value="third"> Third </option>
<option value="fourth"> Fourth </option>
<option value="fifth"> Fifth </option>
<option value="sixth"> Sixth </option>
<option value="seventh"> Seventh </option>
<option value="eighth"> Eighth </option>
<option value="ninth"> Ninth </option>
</select>
</div>
</div>
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-4 col-form-label">Have you used a maiden or different name before?</legend>
<div class="col-sm-8">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="previous_name" id="previous-name-no" value="0" checked="">
<label class="form-check-label" for="previous-name-no"> No </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="previous_name" id="previous-name-yes" value="1">
<label class="form-check-label" for="previous-name-yes"> Yes </label>
</div>
</div>
</div>
</fieldset>
<div class="previous-name-fields" style="display: none;">
<div class="form-group row">
<label for="previous-first-name" class="col-sm-4 col-form-label">Previous First Name</label>
<div class="col-sm-8">
<input type="text" class="form-control required sp-chr-val" id="previous-first-name" name="previous_first_name" value="">
</div>
</div>
<div class="form-group row">
<label for="previous-middle-name" class="col-sm-4 col-form-label">Previous Middle Name <span class="text-muted">(Optional)</span></label>
<div class="col-sm-8">
<input type="text" class="form-control sp-chr-val" id="previous-middle-name" name="previous_middle_name" value="">
</div>
</div>
<div class="form-group row">
<label for="previous-last-name" class="col-sm-4 col-form-label">Previous Last Name</label>
<div class="col-sm-8">
<input type="text" class="form-control required sp-chr-val" id="previous-last-name" name="previous_last_name" value="">
</div>
</div>
<div class="form-group row">
<label for="previous-suffix" class="col-sm-4 col-form-label">Previous Suffix <span class="text-muted">(Optional)</span></label>
<div class="col-sm-8">
<select class="form-control" id="previous-suffix" name="previous_suffix">
<option value="" disabled="" selected="">Select one</option>
<option value="junior"> Junior </option>
<option value="senior"> Senior </option>
<option value="first"> First </option>
<option value="second"> Second </option>
<option value="third"> Third </option>
<option value="fourth"> Fourth </option>
<option value="fifth"> Fifth </option>
<option value="sixth"> Sixth </option>
<option value="seventh"> Seventh </option>
<option value="eighth"> Eighth </option>
<option value="ninth"> Ninth </option>
</select>
</div>
</div>
</div>
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-4 col-form-label">Have you ever used an alias for your name before?</legend>
<div class="col-sm-8">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="alias_name" id="alias-name-no" value="0" checked="">
<label class="form-check-label" for="alias-name-no"> No </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="alias_name" id="alias-name-yes" value="1">
<label class="form-check-label" for="alias-name-yes"> Yes </label>
</div>
</div>
</div>
</fieldset>
<div class="alias-name-fields" style="display: none;">
<div class="form-group row">
<label for="alias-first-name" class="col-sm-4 col-form-label">Alias First Name</label>
<div class="col-sm-8">
<input type="text" class="form-control required sp-chr-val" id="alias-first-name" name="alias_first_name" value="">
</div>
</div>
<div class="form-group row">
<label for="alias-middle-name" class="col-sm-4 col-form-label">Alias Middle Name <span class="text-muted">(Optional)</span></label>
<div class="col-sm-8">
<input type="text" class="form-control sp-chr-val" id="alias-middle-name" name="alias_middle_name" value="">
</div>
</div>
<div class="form-group row">
<label for="alias-last-name" class="col-sm-4 col-form-label">Alias Last Name</label>
<div class="col-sm-8">
<input type="text" class="form-control required sp-chr-val" id="alias-last-name" name="alias_last_name" value="">
</div>
</div>
<div class="form-group row">
<label for="alias-suffix" class="col-sm-4 col-form-label">Alias Suffix <span class="text-muted">(Optional)</span></label>
<div class="col-sm-8">
<select class="form-control" id="alias-suffix" name="alias_suffix">
<option value="" disabled="" selected="">Select one</option>
<option value="junior"> Junior </option>
<option value="senior"> Senior </option>
<option value="first"> First </option>
<option value="second"> Second </option>
<option value="third"> Third </option>
<option value="fourth"> Fourth </option>
<option value="fifth"> Fifth </option>
<option value="sixth"> Sixth </option>
<option value="seventh"> Seventh </option>
<option value="eighth"> Eighth </option>
<option value="ninth"> Ninth </option>
</select>
</div>
</div>
</div>
<div class="form-group row">
<label for="eye-color" class="col-sm-4 col-form-label">Eye Color</label>
<div class="col-sm-8">
<select class="form-control" id="eye-color" name="eye_color" required="">
<option value="" disabled="" selected="">Select eye color</option>
<option value="black">Black</option>
<option value="blue">Blue</option>
<option value="brown">Brown</option>
<option value="gray">Gray</option>
<option value="green">Green</option>
<option value="hazel">Hazel</option>
<option value="maroon">Maroon</option>
<option value="multicolored">Multicolored</option>
<option value="pink">Pink</option>
<option value="unknown">Unknown</option>
</select>
</div>
</div>
<div class="form-group row">
<label for="hair-color" class="col-sm-4 col-form-label">Hair Color</label>
<div class="col-sm-8">
<select class="form-control" id="hair-color" name="hair_color" required="">
<option value="" disabled="" selected="">Select hair color</option>
<option value="bald">Bald</option>
<option value="black">Black</option>
<option value="blond_strawberry">Blond or Strawberry</option>
<option value="brown">Brown</option>
<option value="gray">Gray or Partially Gray</option>
<option value="red_auburn">Red or Auburn</option>
<option value="sandy">Sandy</option>
<option value="white">White</option>
<option value="blue">Blue</option>
<option value="green">Green</option>
<option value="orange">Orange</option>
<option value="pink">Pink</option>
<option value="purple">Purple</option>
<option value="unknown">Unknown</option>
</select>
</div>
</div>
<div class="form-group row">
<label for="height-ft" class="col-sm-4 col-form-label">Height</label>
<div class="col-sm-2 mb-1">
<select class="form-control" id="height-ft" name="height_ft" required="">
<option value="" disabled="" selected="">Select height ft</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
</select>
</div>
<div class="col-sm-2 mb-1">
<select class="form-control" id="height-in" name="height_in" required="">
<option value="" disabled="" selected="">Select height in</option>
<option value="0">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
</select>
</div>
</div>
<div class="form-group row">
<label for="weight" class="col-sm-4 col-form-label">Weight (lbs.)</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="weight" name="weight_lbs" value="" required="">
</div>
</div>
</div>
</div>
<div class="card mt-3">
<div class="card-header">
<h5 class="mb-0">Applicant's Birth Information</h5>
</div>
<div class="card-body">
<div class="form-group row">
<label for="country-birth" class="col-sm-4 col-form-label">Country of Birth</label>
<div class="col-sm-8">
<select class="form-control" id="country-birth" name="country_birth" required="">
<option value="" disabled="" selected="">Select country</option>
<option value="US"> United States </option>
<option value="CA"> Canada </option>
<option value="MX"> Mexico </option>
<option value="AF"> Afghanistan </option>
<option value="AX"> Aland Islands </option>
<option value="AL"> Albania </option>
<option value="DZ"> Algeria </option>
<option value="AS"> American Samoa </option>
<option value="AD"> Andorra </option>
<option value="AO"> Angola </option>
<option value="AI"> Anguilla </option>
<option value="AQ"> Antarctica </option>
<option value="AG"> Antigua And Barbuda </option>
<option value="AR"> Argentina </option>
<option value="AM"> Armenia </option>
<option value="AW"> Aruba </option>
<option value="AU"> Australia </option>
<option value="AT"> Austria </option>
<option value="AZ"> Azerbaijan </option>
<option value="BS"> Bahamas </option>
<option value="BH"> Bahrain </option>
<option value="BD"> Bangladesh </option>
<option value="BB"> Barbados </option>
<option value="BY"> Belarus </option>
<option value="BE"> Belgium </option>
<option value="BZ"> Belize </option>
<option value="BJ"> Benin </option>
<option value="BM"> Bermuda </option>
<option value="BT"> Bhutan </option>
<option value="BO"> Bolivia </option>
<option value="BA"> Bosnia And Herzegovina </option>
<option value="BW"> Botswana </option>
<option value="BV"> Bouvet Island </option>
<option value="BR"> Brazil </option>
<option value="IO"> British Indian Ocean Territory </option>
<option value="BN"> Brunei Darussalam </option>
<option value="BG"> Bulgaria </option>
<option value="BF"> Burkina Faso </option>
<option value="BI"> Burundi </option>
<option value="KH"> Cambodia </option>
<option value="CM"> Cameroon </option>
<option value="CV"> Cape Verde </option>
<option value="KY"> Cayman Islands </option>
<option value="CF"> Central African Republic </option>
<option value="TD"> Chad </option>
<option value="CL"> Chile </option>
<option value="CN"> China </option>
<option value="CX"> Christmas Island </option>
<option value="CC"> Cocos (keeling) Islands </option>
<option value="CO"> Colombia </option>
<option value="KM"> Comoros </option>
<option value="CG"> Congo </option>
<option value="CD"> Congo, Democratic Republic </option>
<option value="CK"> Cook Islands </option>
<option value="CR"> Costa Rica </option>
<option value="CI"> Cote D'ivoire </option>
<option value="HR"> Croatia </option>
<option value="CU"> Cuba </option>
<option value="CY"> Cyprus </option>
<option value="CZ"> Czech Republic </option>
<option value="DK"> Denmark </option>
<option value="DJ"> Djibouti </option>
<option value="DM"> Dominica </option>
<option value="DO"> Dominican Republic </option>
<option value="EC"> Ecuador </option>
<option value="EG"> Egypt </option>
<option value="SV"> El Salvador </option>
<option value="GQ"> Equatorial Guinea </option>
<option value="ER"> Eritrea </option>
<option value="EE"> Estonia </option>
<option value="ET"> Ethiopia </option>
<option value="FK"> Falkland Islands (malvinas) </option>
<option value="FO"> Faroe Islands </option>
<option value="FJ"> Fiji </option>
<option value="FI"> Finland </option>
<option value="FR"> France </option>
<option value="GF"> French Guiana </option>
<option value="PF"> French Polynesia </option>
<option value="TF"> French Southern Territories </option>
<option value="GA"> Gabon </option>
<option value="GM"> Gambia </option>
<option value="GE"> Georgia </option>
<option value="DE"> Germany </option>
<option value="GH"> Ghana </option>
<option value="GI"> Gibraltar </option>
<option value="GR"> Greece </option>
<option value="GL"> Greenland </option>
<option value="GD"> Grenada </option>
<option value="GP"> Guadeloupe </option>
<option value="GU"> Guam </option>
<option value="GT"> Guatemala </option>
<option value="GG"> Guernsey </option>
<option value="GN"> Guinea </option>
<option value="GW"> Guinea-bissau </option>
<option value="GY"> Guyana </option>
<option value="HT"> Haiti </option>
<option value="HM"> Heard Island & Mcdonald Islands </option>
<option value="VA"> Holy See (vatican City State) </option>
<option value="HN"> Honduras </option>
<option value="HK"> Hong Kong </option>
<option value="HU"> Hungary </option>
<option value="IS"> Iceland </option>
<option value="IN"> India </option>
<option value="ID"> Indonesia </option>
<option value="IR"> Iran, Islamic Republic Of </option>
<option value="IQ"> Iraq </option>
<option value="IE"> Ireland </option>
<option value="IM"> Isle Of Man </option>
<option value="IL"> Israel </option>
<option value="IT"> Italy </option>
<option value="JM"> Jamaica </option>
<option value="JP"> Japan </option>
<option value="JE"> Jersey </option>
<option value="JO"> Jordan </option>
<option value="KZ"> Kazakhstan </option>
<option value="KE"> Kenya </option>
<option value="KI"> Kiribati </option>
<option value="KR"> Korea </option>
<option value="KW"> Kuwait </option>
<option value="KG"> Kyrgyzstan </option>
<option value="LA"> Lao People's Democratic Republic </option>
<option value="LV"> Latvia </option>
<option value="LB"> Lebanon </option>
<option value="LS"> Lesotho </option>
<option value="LR"> Liberia </option>
<option value="LY"> Libyan Arab Jamahiriya </option>
<option value="LI"> Liechtenstein </option>
<option value="LT"> Lithuania </option>
<option value="LU"> Luxembourg </option>
<option value="MO"> Macao </option>
<option value="MK"> Macedonia </option>
<option value="MG"> Madagascar </option>
<option value="MW"> Malawi </option>
<option value="MY"> Malaysia </option>
<option value="MV"> Maldives </option>
<option value="ML"> Mali </option>
<option value="MT"> Malta </option>
<option value="MH"> Marshall Islands </option>
<option value="MQ"> Martinique </option>
<option value="MR"> Mauritania </option>
<option value="MU"> Mauritius </option>
<option value="YT"> Mayotte </option>
<option value="FM"> Micronesia, Federated States Of </option>
<option value="MD"> Moldova </option>
<option value="MC"> Monaco </option>
<option value="MN"> Mongolia </option>
<option value="ME"> Montenegro </option>
<option value="MS"> Montserrat </option>
<option value="MA"> Morocco </option>
<option value="MZ"> Mozambique </option>
<option value="MM"> Myanmar </option>
<option value="NA"> Namibia </option>
<option value="NR"> Nauru </option>
<option value="NP"> Nepal </option>
<option value="NL"> Netherlands </option>
<option value="AN"> Netherlands Antilles </option>
<option value="NC"> New Caledonia </option>
<option value="NZ"> New Zealand </option>
<option value="NI"> Nicaragua </option>
<option value="NE"> Niger </option>
<option value="NG"> Nigeria </option>
<option value="NU"> Niue </option>
<option value="NF"> Norfolk Island </option>
<option value="MP"> Northern Mariana Islands </option>
<option value="NO"> Norway </option>
<option value="OM"> Oman </option>
<option value="PK"> Pakistan </option>
<option value="PW"> Palau </option>
<option value="PS"> Palestinian Territory, Occupied </option>
<option value="PA"> Panama </option>
<option value="PG"> Papua New Guinea </option>
<option value="PY"> Paraguay </option>
<option value="PE"> Peru </option>
<option value="PH"> Philippines </option>
<option value="PN"> Pitcairn </option>
<option value="PL"> Poland </option>
<option value="PT"> Portugal </option>
<option value="PR"> Puerto Rico </option>
<option value="QA"> Qatar </option>
<option value="RE"> Reunion </option>
<option value="RO"> Romania </option>
<option value="RU"> Russian Federation </option>
<option value="RW"> Rwanda </option>
<option value="BL"> Saint Barthelemy </option>
<option value="SH"> Saint Helena </option>
<option value="KN"> Saint Kitts And Nevis </option>
<option value="LC"> Saint Lucia </option>
<option value="MF"> Saint Martin </option>
<option value="PM"> Saint Pierre And Miquelon </option>
<option value="VC"> Saint Vincent And Grenadines </option>
<option value="WS"> Samoa </option>
<option value="SM"> San Marino </option>
<option value="ST"> Sao Tome And Principe </option>
<option value="SA"> Saudi Arabia </option>
<option value="SN"> Senegal </option>
<option value="RS"> Serbia </option>
<option value="SC"> Seychelles </option>
<option value="SL"> Sierra Leone </option>
<option value="SG"> Singapore </option>
<option value="SK"> Slovakia </option>
<option value="SI"> Slovenia </option>
<option value="SB"> Solomon Islands </option>
<option value="SO"> Somalia </option>
<option value="ZA"> South Africa </option>
<option value="GS"> South Georgia And Sandwich Isl. </option>
<option value="ES"> Spain </option>
<option value="LK"> Sri Lanka </option>
<option value="SD"> Sudan </option>
<option value="SR"> Suriname </option>
<option value="SJ"> Svalbard And Jan Mayen </option>
<option value="SZ"> Swaziland </option>
<option value="SE"> Sweden </option>
<option value="CH"> Switzerland </option>
<option value="SY"> Syrian Arab Republic </option>
<option value="TW"> Taiwan </option>
<option value="TJ"> Tajikistan </option>
<option value="TZ"> Tanzania </option>
<option value="TH"> Thailand </option>
<option value="TL"> Timor-leste </option>
<option value="TG"> Togo </option>
<option value="TK"> Tokelau </option>
<option value="TO"> Tonga </option>
<option value="TT"> Trinidad And Tobago </option>
<option value="TN"> Tunisia </option>
<option value="TR"> Turkey </option>
<option value="TM"> Turkmenistan </option>
<option value="TC"> Turks And Caicos Islands </option>
<option value="TV"> Tuvalu </option>
<option value="UG"> Uganda </option>
<option value="UA"> Ukraine </option>
<option value="AE"> United Arab Emirates </option>
<option value="GB"> United Kingdom </option>
<option value="UM"> United States Outlying Islands </option>
<option value="UY"> Uruguay </option>
<option value="UZ"> Uzbekistan </option>
<option value="VU"> Vanuatu </option>
<option value="VE"> Venezuela </option>
<option value="VN"> Viet Nam </option>
<option value="VG"> Virgin Islands, British </option>
<option value="VI"> Virgin Islands, U.s. </option>
<option value="WF"> Wallis And Futuna </option>
<option value="EH"> Western Sahara </option>
<option value="YE"> Yemen </option>
<option value="ZM"> Zambia </option>
<option value="ZW"> Zimbabwe </option>
</select>
</div>
</div>
<div class="form-group row">
<label for="city-birth" class="col-sm-4 col-form-label">City of Birth</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="city-birth" name="city_birth" value="" required="">
</div>
</div>
<div class="form-group row state-birth-field" style="display:none;">
<label for="state-birth" class="col-sm-4 col-form-label">State of Birth</label>
<div class="col-sm-8">
<select class="form-control" id="state-birth" name="state_birth" data-old="">
<option value="" disabled="" selected="">Select state</option>
</select>
</div>
</div>
<div class="form-group row state-birth-other-field" style="display:none;">
<label for="state-birth-other" class="col-sm-4 col-form-label">State of Birth</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="state-birth-other" name="state_birth_other" value="">
</div>
</div>
<div class="form-group row">
<label for="dob-year" class="col-sm-4 col-form-label">Date of Birth</label>
<div class="col-sm-2 mb-1">
<select class="form-control" id="dob-year" name="dob_year" required="">
<option value="" disabled="" selected="">Year</option>
<option value="2023"> 2023 </option>
<option value="2022"> 2022 </option>
<option value="2021"> 2021 </option>
<option value="2020"> 2020 </option>
<option value="2019"> 2019 </option>
<option value="2018"> 2018 </option>
<option value="2017"> 2017 </option>
<option value="2016"> 2016 </option>
<option value="2015"> 2015 </option>
<option value="2014"> 2014 </option>
<option value="2013"> 2013 </option>
<option value="2012"> 2012 </option>
<option value="2011"> 2011 </option>
<option value="2010"> 2010 </option>
<option value="2009"> 2009 </option>
<option value="2008"> 2008 </option>
<option value="2007"> 2007 </option>
<option value="2006"> 2006 </option>
<option value="2005"> 2005 </option>
<option value="2004"> 2004 </option>
<option value="2003"> 2003 </option>
<option value="2002"> 2002 </option>
<option value="2001"> 2001 </option>
<option value="2000"> 2000 </option>
<option value="1999"> 1999 </option>
<option value="1998"> 1998 </option>
<option value="1997"> 1997 </option>
<option value="1996"> 1996 </option>
<option value="1995"> 1995 </option>
<option value="1994"> 1994 </option>
<option value="1993"> 1993 </option>
<option value="1992"> 1992 </option>
<option value="1991"> 1991 </option>
<option value="1990"> 1990 </option>
<option value="1989"> 1989 </option>
<option value="1988"> 1988 </option>
<option value="1987"> 1987 </option>
<option value="1986"> 1986 </option>
<option value="1985"> 1985 </option>
<option value="1984"> 1984 </option>
<option value="1983"> 1983 </option>
<option value="1982"> 1982 </option>
<option value="1981"> 1981 </option>
<option value="1980"> 1980 </option>
<option value="1979"> 1979 </option>
<option value="1978"> 1978 </option>
<option value="1977"> 1977 </option>
<option value="1976"> 1976 </option>
<option value="1975"> 1975 </option>
<option value="1974"> 1974 </option>
<option value="1973"> 1973 </option>
<option value="1972"> 1972 </option>
<option value="1971"> 1971 </option>
<option value="1970"> 1970 </option>
<option value="1969"> 1969 </option>
<option value="1968"> 1968 </option>
<option value="1967"> 1967 </option>
<option value="1966"> 1966 </option>
<option value="1965"> 1965 </option>
<option value="1964"> 1964 </option>
<option value="1963"> 1963 </option>
<option value="1962"> 1962 </option>
<option value="1961"> 1961 </option>
<option value="1960"> 1960 </option>
<option value="1959"> 1959 </option>
<option value="1958"> 1958 </option>
<option value="1957"> 1957 </option>
<option value="1956"> 1956 </option>
<option value="1955"> 1955 </option>
<option value="1954"> 1954 </option>
<option value="1953"> 1953 </option>
<option value="1952"> 1952 </option>
<option value="1951"> 1951 </option>
<option value="1950"> 1950 </option>
<option value="1949"> 1949 </option>
<option value="1948"> 1948 </option>
<option value="1947"> 1947 </option>
<option value="1946"> 1946 </option>
<option value="1945"> 1945 </option>
<option value="1944"> 1944 </option>
<option value="1943"> 1943 </option>
<option value="1942"> 1942 </option>
<option value="1941"> 1941 </option>
<option value="1940"> 1940 </option>
<option value="1939"> 1939 </option>
<option value="1938"> 1938 </option>
<option value="1937"> 1937 </option>
<option value="1936"> 1936 </option>
<option value="1935"> 1935 </option>
<option value="1934"> 1934 </option>
<option value="1933"> 1933 </option>
<option value="1932"> 1932 </option>
<option value="1931"> 1931 </option>
<option value="1930"> 1930 </option>
<option value="1929"> 1929 </option>
<option value="1928"> 1928 </option>
<option value="1927"> 1927 </option>
<option value="1926"> 1926 </option>
<option value="1925"> 1925 </option>
<option value="1924"> 1924 </option>
<option value="1923"> 1923 </option>
<option value="1922"> 1922 </option>
<option value="1921"> 1921 </option>
<option value="1920"> 1920 </option>
<option value="1919"> 1919 </option>
<option value="1918"> 1918 </option>
<option value="1917"> 1917 </option>
<option value="1916"> 1916 </option>
<option value="1915"> 1915 </option>
<option value="1914"> 1914 </option>
<option value="1913"> 1913 </option>
<option value="1912"> 1912 </option>
<option value="1911"> 1911 </option>
<option value="1910"> 1910 </option>
<option value="1909"> 1909 </option>
<option value="1908"> 1908 </option>
<option value="1907"> 1907 </option>
<option value="1906"> 1906 </option>
<option value="1905"> 1905 </option>
<option value="1904"> 1904 </option>
<option value="1903"> 1903 </option>
<option value="1902"> 1902 </option>
<option value="1901"> 1901 </option>
<option value="1900"> 1900 </option>
</select>
</div>
<div class="col-sm-2 mb-1">
<select class="form-control" id="dob-month" name="dob_month" placeholder="Month" required="">
<option value="" disabled="" selected="">Month</option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
</select>
</div>
<div class="col-sm-2 mb-1">
<select class="form-control" id="dob-day" name="dob_day" placeholder="Day" required="">
<option value="" disabled="" selected="">Day</option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
<option value="21"> 21 </option>
<option value="22"> 22 </option>
<option value="23"> 23 </option>
<option value="24"> 24 </option>
<option value="25"> 25 </option>
<option value="26"> 26 </option>
<option value="27"> 27 </option>
<option value="28"> 28 </option>
<option value="29"> 29 </option>
<option value="30"> 30 </option>
<option value="31"> 31 </option>
</select>
</div>
</div>
</div>
</div>
<div class="card mt-3">
<div class="card-header">
<h5 class="mb-0">Applicant's Citizenship Information</h5>
</div>
<div class="card-body">
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-4 col-form-label">Are you a US citizen, US National or Lawful Permanent Resident?</legend>
<div class="col-sm-8">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="us_citizen_pr" id="us-citizen-pr-yes" value="1" required="" checked=""checked"">
<label class="form-check-label" for="us-citizen-pr-yes"> Yes </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="us_citizen_pr" id="us-citizen-pr-no" value="0" required="">
<label class="form-check-label" for="us-citizen-pr-no"> No </label>
</div>
</div>
</div>
</fieldset>
<div class="alert alert-danger not-eligible" style="display: none;"> Since you are not a US Citizen, US National, or a Lawful US Permanent Resident, you cannot apply for TSA Pre-Check. </div>
<div class="form-group row">
<label for="country-birth" class="col-sm-4 col-form-label">Country of Citizenship</label>
<div class="col-sm-8">
<select class="form-control" id="country-citizenship" name="country_citizenship" required="">
<option value="" disabled="" selected="">Select country</option>
<option value="US"> United States </option>
<option value="CA"> Canada </option>
<option value="MX"> Mexico </option>
<option value="AF"> Afghanistan </option>
<option value="AX"> Aland Islands </option>
<option value="AL"> Albania </option>
<option value="DZ"> Algeria </option>
<option value="AS"> American Samoa </option>
<option value="AD"> Andorra </option>
<option value="AO"> Angola </option>
<option value="AI"> Anguilla </option>
<option value="AQ"> Antarctica </option>
<option value="AG"> Antigua And Barbuda </option>
<option value="AR"> Argentina </option>
<option value="AM"> Armenia </option>
<option value="AW"> Aruba </option>
<option value="AU"> Australia </option>
<option value="AT"> Austria </option>
<option value="AZ"> Azerbaijan </option>
<option value="BS"> Bahamas </option>
<option value="BH"> Bahrain </option>
<option value="BD"> Bangladesh </option>
<option value="BB"> Barbados </option>
<option value="BY"> Belarus </option>
<option value="BE"> Belgium </option>
<option value="BZ"> Belize </option>
<option value="BJ"> Benin </option>
<option value="BM"> Bermuda </option>
<option value="BT"> Bhutan </option>
<option value="BO"> Bolivia </option>
<option value="BA"> Bosnia And Herzegovina </option>
<option value="BW"> Botswana </option>
<option value="BV"> Bouvet Island </option>
<option value="BR"> Brazil </option>
<option value="IO"> British Indian Ocean Territory </option>
<option value="BN"> Brunei Darussalam </option>
<option value="BG"> Bulgaria </option>
<option value="BF"> Burkina Faso </option>
<option value="BI"> Burundi </option>
<option value="KH"> Cambodia </option>
<option value="CM"> Cameroon </option>
<option value="CV"> Cape Verde </option>
<option value="KY"> Cayman Islands </option>
<option value="CF"> Central African Republic </option>
<option value="TD"> Chad </option>
<option value="CL"> Chile </option>
<option value="CN"> China </option>
<option value="CX"> Christmas Island </option>
<option value="CC"> Cocos (keeling) Islands </option>
<option value="CO"> Colombia </option>
<option value="KM"> Comoros </option>
<option value="CG"> Congo </option>
<option value="CD"> Congo, Democratic Republic </option>
<option value="CK"> Cook Islands </option>
<option value="CR"> Costa Rica </option>
<option value="CI"> Cote D'ivoire </option>
<option value="HR"> Croatia </option>
<option value="CU"> Cuba </option>
<option value="CY"> Cyprus </option>
<option value="CZ"> Czech Republic </option>
<option value="DK"> Denmark </option>
<option value="DJ"> Djibouti </option>
<option value="DM"> Dominica </option>
<option value="DO"> Dominican Republic </option>
<option value="EC"> Ecuador </option>
<option value="EG"> Egypt </option>
<option value="SV"> El Salvador </option>
<option value="GQ"> Equatorial Guinea </option>
<option value="ER"> Eritrea </option>
<option value="EE"> Estonia </option>
<option value="ET"> Ethiopia </option>
<option value="FK"> Falkland Islands (malvinas) </option>
<option value="FO"> Faroe Islands </option>
<option value="FJ"> Fiji </option>
<option value="FI"> Finland </option>
<option value="FR"> France </option>
<option value="GF"> French Guiana </option>
<option value="PF"> French Polynesia </option>
<option value="TF"> French Southern Territories </option>
<option value="GA"> Gabon </option>
<option value="GM"> Gambia </option>
<option value="GE"> Georgia </option>
<option value="DE"> Germany </option>
<option value="GH"> Ghana </option>
<option value="GI"> Gibraltar </option>
<option value="GR"> Greece </option>
<option value="GL"> Greenland </option>
<option value="GD"> Grenada </option>
<option value="GP"> Guadeloupe </option>
<option value="GU"> Guam </option>
<option value="GT"> Guatemala </option>
<option value="GG"> Guernsey </option>
<option value="GN"> Guinea </option>
<option value="GW"> Guinea-bissau </option>
<option value="GY"> Guyana </option>
<option value="HT"> Haiti </option>
<option value="HM"> Heard Island & Mcdonald Islands </option>
<option value="VA"> Holy See (vatican City State) </option>
<option value="HN"> Honduras </option>
<option value="HK"> Hong Kong </option>
<option value="HU"> Hungary </option>
<option value="IS"> Iceland </option>
<option value="IN"> India </option>
<option value="ID"> Indonesia </option>
<option value="IR"> Iran, Islamic Republic Of </option>
<option value="IQ"> Iraq </option>
<option value="IE"> Ireland </option>
<option value="IM"> Isle Of Man </option>
<option value="IL"> Israel </option>
<option value="IT"> Italy </option>
<option value="JM"> Jamaica </option>
<option value="JP"> Japan </option>
<option value="JE"> Jersey </option>
<option value="JO"> Jordan </option>
<option value="KZ"> Kazakhstan </option>
<option value="KE"> Kenya </option>
<option value="KI"> Kiribati </option>
<option value="KR"> Korea </option>
<option value="KW"> Kuwait </option>
<option value="KG"> Kyrgyzstan </option>
<option value="LA"> Lao People's Democratic Republic </option>
<option value="LV"> Latvia </option>
<option value="LB"> Lebanon </option>
<option value="LS"> Lesotho </option>
<option value="LR"> Liberia </option>
<option value="LY"> Libyan Arab Jamahiriya </option>
<option value="LI"> Liechtenstein </option>
<option value="LT"> Lithuania </option>
<option value="LU"> Luxembourg </option>
<option value="MO"> Macao </option>
<option value="MK"> Macedonia </option>
<option value="MG"> Madagascar </option>
<option value="MW"> Malawi </option>
<option value="MY"> Malaysia </option>
<option value="MV"> Maldives </option>
<option value="ML"> Mali </option>
<option value="MT"> Malta </option>
<option value="MH"> Marshall Islands </option>
<option value="MQ"> Martinique </option>
<option value="MR"> Mauritania </option>
<option value="MU"> Mauritius </option>
<option value="YT"> Mayotte </option>
<option value="FM"> Micronesia, Federated States Of </option>
<option value="MD"> Moldova </option>
<option value="MC"> Monaco </option>
<option value="MN"> Mongolia </option>
<option value="ME"> Montenegro </option>
<option value="MS"> Montserrat </option>
<option value="MA"> Morocco </option>
<option value="MZ"> Mozambique </option>
<option value="MM"> Myanmar </option>
<option value="NA"> Namibia </option>
<option value="NR"> Nauru </option>
<option value="NP"> Nepal </option>
<option value="NL"> Netherlands </option>
<option value="AN"> Netherlands Antilles </option>
<option value="NC"> New Caledonia </option>
<option value="NZ"> New Zealand </option>
<option value="NI"> Nicaragua </option>
<option value="NE"> Niger </option>
<option value="NG"> Nigeria </option>
<option value="NU"> Niue </option>
<option value="NF"> Norfolk Island </option>
<option value="MP"> Northern Mariana Islands </option>
<option value="NO"> Norway </option>
<option value="OM"> Oman </option>
<option value="PK"> Pakistan </option>
<option value="PW"> Palau </option>
<option value="PS"> Palestinian Territory, Occupied </option>
<option value="PA"> Panama </option>
<option value="PG"> Papua New Guinea </option>
<option value="PY"> Paraguay </option>
<option value="PE"> Peru </option>
<option value="PH"> Philippines </option>
<option value="PN"> Pitcairn </option>
<option value="PL"> Poland </option>
<option value="PT"> Portugal </option>
<option value="PR"> Puerto Rico </option>
<option value="QA"> Qatar </option>
<option value="RE"> Reunion </option>
<option value="RO"> Romania </option>
<option value="RU"> Russian Federation </option>
<option value="RW"> Rwanda </option>
<option value="BL"> Saint Barthelemy </option>
<option value="SH"> Saint Helena </option>
<option value="KN"> Saint Kitts And Nevis </option>
<option value="LC"> Saint Lucia </option>
<option value="MF"> Saint Martin </option>
<option value="PM"> Saint Pierre And Miquelon </option>
<option value="VC"> Saint Vincent And Grenadines </option>
<option value="WS"> Samoa </option>
<option value="SM"> San Marino </option>
<option value="ST"> Sao Tome And Principe </option>
<option value="SA"> Saudi Arabia </option>
<option value="SN"> Senegal </option>
<option value="RS"> Serbia </option>
<option value="SC"> Seychelles </option>
<option value="SL"> Sierra Leone </option>
<option value="SG"> Singapore </option>
<option value="SK"> Slovakia </option>
<option value="SI"> Slovenia </option>
<option value="SB"> Solomon Islands </option>
<option value="SO"> Somalia </option>
<option value="ZA"> South Africa </option>
<option value="GS"> South Georgia And Sandwich Isl. </option>
<option value="ES"> Spain </option>
<option value="LK"> Sri Lanka </option>
<option value="SD"> Sudan </option>
<option value="SR"> Suriname </option>
<option value="SJ"> Svalbard And Jan Mayen </option>
<option value="SZ"> Swaziland </option>
<option value="SE"> Sweden </option>
<option value="CH"> Switzerland </option>
<option value="SY"> Syrian Arab Republic </option>
<option value="TW"> Taiwan </option>
<option value="TJ"> Tajikistan </option>
<option value="TZ"> Tanzania </option>
<option value="TH"> Thailand </option>
<option value="TL"> Timor-leste </option>
<option value="TG"> Togo </option>
<option value="TK"> Tokelau </option>
<option value="TO"> Tonga </option>
<option value="TT"> Trinidad And Tobago </option>
<option value="TN"> Tunisia </option>
<option value="TR"> Turkey </option>
<option value="TM"> Turkmenistan </option>
<option value="TC"> Turks And Caicos Islands </option>
<option value="TV"> Tuvalu </option>
<option value="UG"> Uganda </option>
<option value="UA"> Ukraine </option>
<option value="AE"> United Arab Emirates </option>
<option value="GB"> United Kingdom </option>
<option value="UM"> United States Outlying Islands </option>
<option value="UY"> Uruguay </option>
<option value="UZ"> Uzbekistan </option>
<option value="VU"> Vanuatu </option>
<option value="VE"> Venezuela </option>
<option value="VN"> Viet Nam </option>
<option value="VG"> Virgin Islands, British </option>
<option value="VI"> Virgin Islands, U.s. </option>
<option value="WF"> Wallis And Futuna </option>
<option value="EH"> Western Sahara </option>
<option value="YE"> Yemen </option>
<option value="ZM"> Zambia </option>
<option value="ZW"> Zimbabwe </option>
</select>
</div>
</div>
</div>
</div>
<div class="card mt-3">
<div class="card-header">
<h5 class="mb-0">Address</h5>
</div>
<div class="card-body">
<div class="form-group row">
<label for="mailing-country" class="col-sm-4 col-form-label">Country</label>
<div class="col-sm-8">
<select class="form-control" id="mailing-country" name="mailing_country" required="">
<option value="" disabled="" selected="">Select country</option>
<option value="US"> United States </option>
<option value="CA"> Canada </option>
<option value="MX"> Mexico </option>
<option value="AF"> Afghanistan </option>
<option value="AX"> Aland Islands </option>
<option value="AL"> Albania </option>
<option value="DZ"> Algeria </option>
<option value="AS"> American Samoa </option>
<option value="AD"> Andorra </option>
<option value="AO"> Angola </option>
<option value="AI"> Anguilla </option>
<option value="AQ"> Antarctica </option>
<option value="AG"> Antigua And Barbuda </option>
<option value="AR"> Argentina </option>
<option value="AM"> Armenia </option>
<option value="AW"> Aruba </option>
<option value="AU"> Australia </option>
<option value="AT"> Austria </option>
<option value="AZ"> Azerbaijan </option>
<option value="BS"> Bahamas </option>
<option value="BH"> Bahrain </option>
<option value="BD"> Bangladesh </option>
<option value="BB"> Barbados </option>
<option value="BE"> Belgium </option>
<option value="BZ"> Belize </option>
<option value="BJ"> Benin </option>
<option value="BM"> Bermuda </option>
<option value="BT"> Bhutan </option>
<option value="BO"> Bolivia </option>
<option value="BA"> Bosnia And Herzegovina </option>
<option value="BW"> Botswana </option>
<option value="BV"> Bouvet Island </option>
<option value="BR"> Brazil </option>
<option value="IO"> British Indian Ocean Territory </option>
<option value="BN"> Brunei Darussalam </option>
<option value="BG"> Bulgaria </option>
<option value="BF"> Burkina Faso </option>
<option value="KH"> Cambodia </option>
<option value="CM"> Cameroon </option>
<option value="CV"> Cape Verde </option>
<option value="KY"> Cayman Islands </option>
<option value="TD"> Chad </option>
<option value="CL"> Chile </option>
<option value="CN"> China </option>
<option value="CX"> Christmas Island </option>
<option value="CC"> Cocos (keeling) Islands </option>
<option value="CO"> Colombia </option>
<option value="KM"> Comoros </option>
<option value="CG"> Congo </option>
<option value="CK"> Cook Islands </option>
<option value="CR"> Costa Rica </option>
<option value="CI"> Cote D'ivoire </option>
<option value="HR"> Croatia </option>
<option value="CY"> Cyprus </option>
<option value="CZ"> Czech Republic </option>
<option value="DK"> Denmark </option>
<option value="DJ"> Djibouti </option>
<option value="DM"> Dominica </option>
<option value="DO"> Dominican Republic </option>
<option value="EC"> Ecuador </option>
<option value="EG"> Egypt </option>
<option value="SV"> El Salvador </option>
<option value="GQ"> Equatorial Guinea </option>
<option value="ER"> Eritrea </option>
<option value="EE"> Estonia </option>
<option value="ET"> Ethiopia </option>
<option value="FK"> Falkland Islands (malvinas) </option>
<option value="FO"> Faroe Islands </option>
<option value="FJ"> Fiji </option>
<option value="FI"> Finland </option>
<option value="FR"> France </option>
<option value="GF"> French Guiana </option>
<option value="PF"> French Polynesia </option>
<option value="TF"> French Southern Territories </option>
<option value="GA"> Gabon </option>
<option value="GM"> Gambia </option>
<option value="GE"> Georgia </option>
<option value="DE"> Germany </option>
<option value="GH"> Ghana </option>
<option value="GI"> Gibraltar </option>
<option value="GR"> Greece </option>
<option value="GL"> Greenland </option>
<option value="GD"> Grenada </option>
<option value="GP"> Guadeloupe </option>
<option value="GU"> Guam </option>
<option value="GT"> Guatemala </option>
<option value="GG"> Guernsey </option>
<option value="GN"> Guinea </option>
<option value="GW"> Guinea-bissau </option>
<option value="GY"> Guyana </option>
<option value="HT"> Haiti </option>
<option value="HM"> Heard Island & Mcdonald Islands </option>
<option value="VA"> Holy See (vatican City State) </option>
<option value="HN"> Honduras </option>
<option value="HK"> Hong Kong </option>
<option value="HU"> Hungary </option>
<option value="IS"> Iceland </option>
<option value="IN"> India </option>
<option value="ID"> Indonesia </option>
<option value="IE"> Ireland </option>
<option value="IM"> Isle Of Man </option>
<option value="IL"> Israel </option>
<option value="IT"> Italy </option>
<option value="JM"> Jamaica </option>
<option value="JP"> Japan </option>
<option value="JE"> Jersey </option>
<option value="JO"> Jordan </option>
<option value="KZ"> Kazakhstan </option>
<option value="KE"> Kenya </option>
<option value="KI"> Kiribati </option>
<option value="KR"> Korea </option>
<option value="KW"> Kuwait </option>
<option value="KG"> Kyrgyzstan </option>
<option value="LA"> Lao People's Democratic Republic </option>
<option value="LV"> Latvia </option>
<option value="LS"> Lesotho </option>
<option value="LR"> Liberia </option>
<option value="LI"> Liechtenstein </option>
<option value="LT"> Lithuania </option>
<option value="LU"> Luxembourg </option>
<option value="MO"> Macao </option>
<option value="MK"> Macedonia </option>
<option value="MG"> Madagascar </option>
<option value="MW"> Malawi </option>
<option value="MY"> Malaysia </option>
<option value="MV"> Maldives </option>
<option value="MT"> Malta </option>
<option value="MH"> Marshall Islands </option>
<option value="MQ"> Martinique </option>
<option value="MR"> Mauritania </option>
<option value="MU"> Mauritius </option>
<option value="YT"> Mayotte </option>
<option value="FM"> Micronesia, Federated States Of </option>
<option value="MD"> Moldova </option>
<option value="MC"> Monaco </option>
<option value="MN"> Mongolia </option>
<option value="ME"> Montenegro </option>
<option value="MS"> Montserrat </option>
<option value="MA"> Morocco </option>
<option value="MZ"> Mozambique </option>
<option value="MM"> Myanmar </option>
<option value="NA"> Namibia </option>
<option value="NR"> Nauru </option>
<option value="NP"> Nepal </option>
<option value="NL"> Netherlands </option>
<option value="AN"> Netherlands Antilles </option>
<option value="NC"> New Caledonia </option>
<option value="NZ"> New Zealand </option>
<option value="NE"> Niger </option>
<option value="NG"> Nigeria </option>
<option value="NU"> Niue </option>
<option value="NF"> Norfolk Island </option>
<option value="MP"> Northern Mariana Islands </option>
<option value="NO"> Norway </option>
<option value="OM"> Oman </option>
<option value="PK"> Pakistan </option>
<option value="PW"> Palau </option>
<option value="PS"> Palestinian Territory, Occupied </option>
<option value="PA"> Panama </option>
<option value="PG"> Papua New Guinea </option>
<option value="PY"> Paraguay </option>
<option value="PE"> Peru </option>
<option value="PH"> Philippines </option>
<option value="PN"> Pitcairn </option>
<option value="PL"> Poland </option>
<option value="PT"> Portugal </option>
<option value="PR"> Puerto Rico </option>
<option value="QA"> Qatar </option>
<option value="RE"> Reunion </option>
<option value="RO"> Romania </option>
<option value="RU"> Russian Federation </option>
<option value="RW"> Rwanda </option>
<option value="BL"> Saint Barthelemy </option>
<option value="SH"> Saint Helena </option>
<option value="KN"> Saint Kitts And Nevis </option>
<option value="LC"> Saint Lucia </option>
<option value="MF"> Saint Martin </option>
<option value="PM"> Saint Pierre And Miquelon </option>
<option value="VC"> Saint Vincent And Grenadines </option>
<option value="WS"> Samoa </option>
<option value="SM"> San Marino </option>
<option value="ST"> Sao Tome And Principe </option>
<option value="SA"> Saudi Arabia </option>
<option value="SN"> Senegal </option>
<option value="RS"> Serbia </option>
<option value="SC"> Seychelles </option>
<option value="SL"> Sierra Leone </option>
<option value="SG"> Singapore </option>
<option value="SK"> Slovakia </option>
<option value="SI"> Slovenia </option>
<option value="SB"> Solomon Islands </option>
<option value="ZA"> South Africa </option>
<option value="GS"> South Georgia And Sandwich Isl. </option>
<option value="ES"> Spain </option>
<option value="LK"> Sri Lanka </option>
<option value="SR"> Suriname </option>
<option value="SJ"> Svalbard And Jan Mayen </option>
<option value="SZ"> Swaziland </option>
<option value="SE"> Sweden </option>
<option value="CH"> Switzerland </option>
<option value="TW"> Taiwan </option>
<option value="TJ"> Tajikistan </option>
<option value="TZ"> Tanzania </option>
<option value="TH"> Thailand </option>
<option value="TL"> Timor-leste </option>
<option value="TG"> Togo </option>
<option value="TK"> Tokelau </option>
<option value="TO"> Tonga </option>
<option value="TT"> Trinidad And Tobago </option>
<option value="TN"> Tunisia </option>
<option value="TR"> Turkey </option>
<option value="TM"> Turkmenistan </option>
<option value="TC"> Turks And Caicos Islands </option>
<option value="TV"> Tuvalu </option>
<option value="UG"> Uganda </option>
<option value="AE"> United Arab Emirates </option>
<option value="GB"> United Kingdom </option>
<option value="UM"> United States Outlying Islands </option>
<option value="UY"> Uruguay </option>
<option value="UZ"> Uzbekistan </option>
<option value="VU"> Vanuatu </option>
<option value="VN"> Viet Nam </option>
<option value="VG"> Virgin Islands, British </option>
<option value="VI"> Virgin Islands, U.s. </option>
<option value="WF"> Wallis And Futuna </option>
<option value="EH"> Western Sahara </option>
<option value="ZM"> Zambia </option>
</select>
</div>
</div>
<div class="form-group row">
<label for="mailing-line-1" class="col-sm-4 col-form-label">Address Line 1</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="mailing-line-1" name="mailing_line_1" value="" required="">
</div>
</div>
<div class="form-group row">
<label for="mailing-line-2" class="col-sm-4 col-form-label">Address Line 2 <span class="text-muted">(Apartment, Unit, Suite, Etc.)</span></label>
<div class="col-sm-8">
<input type="text" class="form-control" id="mailing-line-2" name="mailing_line_2" value="">
</div>
</div>
<div class="form-group row">
<label for="mailing-city" class="col-sm-4 col-form-label">City</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="mailing-city" name="mailing_city" value="" required="">
</div>
</div>
<div class="form-group row mailing-state-field" style="display:none;">
<label for="mailing-state" class="col-sm-4 col-form-label">State</label>
<div class="col-sm-8">
<select class="form-control" id="mailing-state" name="mailing_state" data-old="">
<option value="" disabled="" selected="">Select state</option>
</select>
</div>
</div>
<div class="form-group row mailing-state-other-field" style="display:none;">
<label for="mailing-state-other" class="col-sm-4 col-form-label">State</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="mailing-state-other" name="mailing_state_other" value="">
</div>
</div>
<div class="form-group row">
<label for="mailing-zip-code" class="col-sm-4 col-form-label">Zip Code</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="mailing-zip-code" name="mailing_zip_code" value="" maxlength="5" pattern="[0-9]{5}" title="Zip code should contain only 5 numbers. Please do not enter any letters." required="">
</div>
</div>
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-4 col-form-label">Is your mailing address the same as your residential address?</legend>
<div class="col-sm-8">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="residential_address" id="residential-address-yes" value="1" required="" checked=""checked"">
<label class="form-check-label" for="residential-address-yes"> Yes </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="residential_address" id="residential-address-no" value="0" required="">
<label class="form-check-label" for="residential-address-no"> No </label>
</div>
</div>
</div>
</fieldset>
<div class="residential-address" style="display: none;">
<div class="form-group row">
<label for="residential-country" class="col-sm-4 col-form-label">Residential Country</label>
<div class="col-sm-8">
<select class="form-control required" id="residential-country" name="residential_country">
<option value="" disabled="" selected="">Select country</option>
<option value="US"> United States </option>
<option value="CA"> Canada </option>
<option value="MX"> Mexico </option>
<option value="AF"> Afghanistan </option>
<option value="AX"> Aland Islands </option>
<option value="AL"> Albania </option>
<option value="DZ"> Algeria </option>
<option value="AS"> American Samoa </option>
<option value="AD"> Andorra </option>
<option value="AO"> Angola </option>
<option value="AI"> Anguilla </option>
<option value="AQ"> Antarctica </option>
<option value="AG"> Antigua And Barbuda </option>
<option value="AR"> Argentina </option>
<option value="AM"> Armenia </option>
<option value="AW"> Aruba </option>
<option value="AU"> Australia </option>
<option value="AT"> Austria </option>
<option value="AZ"> Azerbaijan </option>
<option value="BS"> Bahamas </option>
<option value="BH"> Bahrain </option>
<option value="BD"> Bangladesh </option>
<option value="BB"> Barbados </option>
<option value="BY"> Belarus </option>
<option value="BE"> Belgium </option>
<option value="BZ"> Belize </option>
<option value="BJ"> Benin </option>
<option value="BM"> Bermuda </option>
<option value="BT"> Bhutan </option>
<option value="BO"> Bolivia </option>
<option value="BA"> Bosnia And Herzegovina </option>
<option value="BW"> Botswana </option>
<option value="BV"> Bouvet Island </option>
<option value="BR"> Brazil </option>
<option value="IO"> British Indian Ocean Territory </option>
<option value="BN"> Brunei Darussalam </option>
<option value="BG"> Bulgaria </option>
<option value="BF"> Burkina Faso </option>
<option value="BI"> Burundi </option>
<option value="KH"> Cambodia </option>
<option value="CM"> Cameroon </option>
<option value="CV"> Cape Verde </option>
<option value="KY"> Cayman Islands </option>
<option value="CF"> Central African Republic </option>
<option value="TD"> Chad </option>
<option value="CL"> Chile </option>
<option value="CN"> China </option>
<option value="CX"> Christmas Island </option>
<option value="CC"> Cocos (keeling) Islands </option>
<option value="CO"> Colombia </option>
<option value="KM"> Comoros </option>
<option value="CG"> Congo </option>
<option value="CD"> Congo, Democratic Republic </option>
<option value="CK"> Cook Islands </option>
<option value="CR"> Costa Rica </option>
<option value="CI"> Cote D'ivoire </option>
<option value="HR"> Croatia </option>
<option value="CU"> Cuba </option>
<option value="CY"> Cyprus </option>
<option value="CZ"> Czech Republic </option>
<option value="DK"> Denmark </option>
<option value="DJ"> Djibouti </option>
<option value="DM"> Dominica </option>
<option value="DO"> Dominican Republic </option>
<option value="EC"> Ecuador </option>
<option value="EG"> Egypt </option>
<option value="SV"> El Salvador </option>
<option value="GQ"> Equatorial Guinea </option>
<option value="ER"> Eritrea </option>
<option value="EE"> Estonia </option>
<option value="ET"> Ethiopia </option>
<option value="FK"> Falkland Islands (malvinas) </option>
<option value="FO"> Faroe Islands </option>
<option value="FJ"> Fiji </option>
<option value="FI"> Finland </option>
<option value="FR"> France </option>
<option value="GF"> French Guiana </option>
<option value="PF"> French Polynesia </option>
<option value="TF"> French Southern Territories </option>
<option value="GA"> Gabon </option>
<option value="GM"> Gambia </option>
<option value="GE"> Georgia </option>
<option value="DE"> Germany </option>
<option value="GH"> Ghana </option>
<option value="GI"> Gibraltar </option>
<option value="GR"> Greece </option>
<option value="GL"> Greenland </option>
<option value="GD"> Grenada </option>
<option value="GP"> Guadeloupe </option>
<option value="GU"> Guam </option>
<option value="GT"> Guatemala </option>
<option value="GG"> Guernsey </option>
<option value="GN"> Guinea </option>
<option value="GW"> Guinea-bissau </option>
<option value="GY"> Guyana </option>
<option value="HT"> Haiti </option>
<option value="HM"> Heard Island & Mcdonald Islands </option>
<option value="VA"> Holy See (vatican City State) </option>
<option value="HN"> Honduras </option>
<option value="HK"> Hong Kong </option>
<option value="HU"> Hungary </option>
<option value="IS"> Iceland </option>
<option value="IN"> India </option>
<option value="ID"> Indonesia </option>
<option value="IR"> Iran, Islamic Republic Of </option>
<option value="IQ"> Iraq </option>
<option value="IE"> Ireland </option>
<option value="IM"> Isle Of Man </option>
<option value="IL"> Israel </option>
<option value="IT"> Italy </option>
<option value="JM"> Jamaica </option>
<option value="JP"> Japan </option>
<option value="JE"> Jersey </option>
<option value="JO"> Jordan </option>
<option value="KZ"> Kazakhstan </option>
<option value="KE"> Kenya </option>
<option value="KI"> Kiribati </option>
<option value="KR"> Korea </option>
<option value="KW"> Kuwait </option>
<option value="KG"> Kyrgyzstan </option>
<option value="LA"> Lao People's Democratic Republic </option>
<option value="LV"> Latvia </option>
<option value="LB"> Lebanon </option>
<option value="LS"> Lesotho </option>
<option value="LR"> Liberia </option>
<option value="LY"> Libyan Arab Jamahiriya </option>
<option value="LI"> Liechtenstein </option>
<option value="LT"> Lithuania </option>
<option value="LU"> Luxembourg </option>
<option value="MO"> Macao </option>
<option value="MK"> Macedonia </option>
<option value="MG"> Madagascar </option>
<option value="MW"> Malawi </option>
<option value="MY"> Malaysia </option>
<option value="MV"> Maldives </option>
<option value="ML"> Mali </option>
<option value="MT"> Malta </option>
<option value="MH"> Marshall Islands </option>
<option value="MQ"> Martinique </option>
<option value="MR"> Mauritania </option>
<option value="MU"> Mauritius </option>
<option value="YT"> Mayotte </option>
<option value="FM"> Micronesia, Federated States Of </option>
<option value="MD"> Moldova </option>
<option value="MC"> Monaco </option>
<option value="MN"> Mongolia </option>
<option value="ME"> Montenegro </option>
<option value="MS"> Montserrat </option>
<option value="MA"> Morocco </option>
<option value="MZ"> Mozambique </option>
<option value="MM"> Myanmar </option>
<option value="NA"> Namibia </option>
<option value="NR"> Nauru </option>
<option value="NP"> Nepal </option>
<option value="NL"> Netherlands </option>
<option value="AN"> Netherlands Antilles </option>
<option value="NC"> New Caledonia </option>
<option value="NZ"> New Zealand </option>
<option value="NI"> Nicaragua </option>
<option value="NE"> Niger </option>
<option value="NG"> Nigeria </option>
<option value="NU"> Niue </option>
<option value="NF"> Norfolk Island </option>
<option value="MP"> Northern Mariana Islands </option>
<option value="NO"> Norway </option>
<option value="OM"> Oman </option>
<option value="PK"> Pakistan </option>
<option value="PW"> Palau </option>
<option value="PS"> Palestinian Territory, Occupied </option>
<option value="PA"> Panama </option>
<option value="PG"> Papua New Guinea </option>
<option value="PY"> Paraguay </option>
<option value="PE"> Peru </option>
<option value="PH"> Philippines </option>
<option value="PN"> Pitcairn </option>
<option value="PL"> Poland </option>
<option value="PT"> Portugal </option>
<option value="PR"> Puerto Rico </option>
<option value="QA"> Qatar </option>
<option value="RE"> Reunion </option>
<option value="RO"> Romania </option>
<option value="RU"> Russian Federation </option>
<option value="RW"> Rwanda </option>
<option value="BL"> Saint Barthelemy </option>
<option value="SH"> Saint Helena </option>
<option value="KN"> Saint Kitts And Nevis </option>
<option value="LC"> Saint Lucia </option>
<option value="MF"> Saint Martin </option>
<option value="PM"> Saint Pierre And Miquelon </option>
<option value="VC"> Saint Vincent And Grenadines </option>
<option value="WS"> Samoa </option>
<option value="SM"> San Marino </option>
<option value="ST"> Sao Tome And Principe </option>
<option value="SA"> Saudi Arabia </option>
<option value="SN"> Senegal </option>
<option value="RS"> Serbia </option>
<option value="SC"> Seychelles </option>
<option value="SL"> Sierra Leone </option>
<option value="SG"> Singapore </option>
<option value="SK"> Slovakia </option>
<option value="SI"> Slovenia </option>
<option value="SB"> Solomon Islands </option>
<option value="SO"> Somalia </option>
<option value="ZA"> South Africa </option>
<option value="GS"> South Georgia And Sandwich Isl. </option>
<option value="ES"> Spain </option>
<option value="LK"> Sri Lanka </option>
<option value="SD"> Sudan </option>
<option value="SR"> Suriname </option>
<option value="SJ"> Svalbard And Jan Mayen </option>
<option value="SZ"> Swaziland </option>
<option value="SE"> Sweden </option>
<option value="CH"> Switzerland </option>
<option value="SY"> Syrian Arab Republic </option>
<option value="TW"> Taiwan </option>
<option value="TJ"> Tajikistan </option>
<option value="TZ"> Tanzania </option>
<option value="TH"> Thailand </option>
<option value="TL"> Timor-leste </option>
<option value="TG"> Togo </option>
<option value="TK"> Tokelau </option>
<option value="TO"> Tonga </option>
<option value="TT"> Trinidad And Tobago </option>
<option value="TN"> Tunisia </option>
<option value="TR"> Turkey </option>
<option value="TM"> Turkmenistan </option>
<option value="TC"> Turks And Caicos Islands </option>
<option value="TV"> Tuvalu </option>
<option value="UG"> Uganda </option>
<option value="UA"> Ukraine </option>
<option value="AE"> United Arab Emirates </option>
<option value="GB"> United Kingdom </option>
<option value="UM"> United States Outlying Islands </option>
<option value="UY"> Uruguay </option>
<option value="UZ"> Uzbekistan </option>
<option value="VU"> Vanuatu </option>
<option value="VE"> Venezuela </option>
<option value="VN"> Viet Nam </option>
<option value="VG"> Virgin Islands, British </option>
<option value="VI"> Virgin Islands, U.s. </option>
<option value="WF"> Wallis And Futuna </option>
<option value="EH"> Western Sahara </option>
<option value="YE"> Yemen </option>
<option value="ZM"> Zambia </option>
<option value="ZW"> Zimbabwe </option>
</select>
</div>
</div>
<div class="form-group row">
<label for="residential-line-1" class="col-sm-4 col-form-label">Residential Address Line 1</label>
<div class="col-sm-8">
<input type="text" class="form-control required" id="residential-line-1" name="residential_line_1" value="">
</div>
</div>
<div class="form-group row">
<label for="residential-line-2" class="col-sm-4 col-form-label">Residential Address Line 2 <span class="text-muted">(Apartment, Unit, Suite, Etc.)</span></label>
<div class="col-sm-8">
<input type="text" class="form-control" id="residential-line-2" name="residential_line_2" value="">
</div>
</div>
<div class="form-group row">
<label for="residential-city" class="col-sm-4 col-form-label">Residential City</label>
<div class="col-sm-8">
<input type="text" class="form-control required" id="residential-city" name="residential_city" value="">
</div>
</div>
<div class="form-group row residential-state-field" style="display:none;">
<label for="residential-state" class="col-sm-4 col-form-label">Residential State</label>
<div class="col-sm-8">
<select class="form-control" id="residential-state" name="residential_state" data-old="">
<option value="" disabled="" selected="">Select state</option>
</select>
</div>
</div>
<div class="form-group row residential-state-other-field" style="display:none;">
<label for="residential-state-other" class="col-sm-4 col-form-label">Residential State</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="residential-state-other" name="residential_state_other" value="">
</div>
</div>
<div class="form-group row">
<label for="residential-zip-code" class="col-sm-4 col-form-label">Residential Zip Code</label>
<div class="col-sm-8">
<input type="text" class="form-control required" id="residential-zip-code" name="residential_zip_code" maxlength="5" pattern="[0-9]{5}" title="Zip code should contain only 5 numbers. Please do not enter any letters." value="">
</div>
</div>
</div>
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-4 col-form-label">Have you lived at your current address for more than 5 years?</legend>
<div class="col-sm-8">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="previous_address" id="previous-address-yes" value="1" required="" checked=""checked"">
<label class="form-check-label" for="previous-address-yes"> Yes </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="previous_address" id="previous-address-no" value="0" required="">
<label class="form-check-label" for="previous-address-no"> No </label>
</div>
</div>
</div>
</fieldset>
<div class="previous-address" style="display: none;">
<div class="form-group row">
<label for="previous-country" class="col-sm-4 col-form-label">Previous Country</label>
<div class="col-sm-8">
<select class="form-control required" id="previous-country" name="previous_country">
<option value="" disabled="" selected="">Select country</option>
<option value="US"> United States </option>
<option value="CA"> Canada </option>
<option value="MX"> Mexico </option>
<option value="AF"> Afghanistan </option>
<option value="AX"> Aland Islands </option>
<option value="AL"> Albania </option>
<option value="DZ"> Algeria </option>
<option value="AS"> American Samoa </option>
<option value="AD"> Andorra </option>
<option value="AO"> Angola </option>
<option value="AI"> Anguilla </option>
<option value="AQ"> Antarctica </option>
<option value="AG"> Antigua And Barbuda </option>
<option value="AR"> Argentina </option>
<option value="AM"> Armenia </option>
<option value="AW"> Aruba </option>
<option value="AU"> Australia </option>
<option value="AT"> Austria </option>
<option value="AZ"> Azerbaijan </option>
<option value="BS"> Bahamas </option>
<option value="BH"> Bahrain </option>
<option value="BD"> Bangladesh </option>
<option value="BB"> Barbados </option>
<option value="BY"> Belarus </option>
<option value="BE"> Belgium </option>
<option value="BZ"> Belize </option>
<option value="BJ"> Benin </option>
<option value="BM"> Bermuda </option>
<option value="BT"> Bhutan </option>
<option value="BO"> Bolivia </option>
<option value="BA"> Bosnia And Herzegovina </option>
<option value="BW"> Botswana </option>
<option value="BV"> Bouvet Island </option>
<option value="BR"> Brazil </option>
<option value="IO"> British Indian Ocean Territory </option>
<option value="BN"> Brunei Darussalam </option>
<option value="BG"> Bulgaria </option>
<option value="BF"> Burkina Faso </option>
<option value="BI"> Burundi </option>
<option value="KH"> Cambodia </option>
<option value="CM"> Cameroon </option>
<option value="CV"> Cape Verde </option>
<option value="KY"> Cayman Islands </option>
<option value="CF"> Central African Republic </option>
<option value="TD"> Chad </option>
<option value="CL"> Chile </option>
<option value="CN"> China </option>
<option value="CX"> Christmas Island </option>
<option value="CC"> Cocos (keeling) Islands </option>
<option value="CO"> Colombia </option>
<option value="KM"> Comoros </option>
<option value="CG"> Congo </option>
<option value="CD"> Congo, Democratic Republic </option>
<option value="CK"> Cook Islands </option>
<option value="CR"> Costa Rica </option>
<option value="CI"> Cote D'ivoire </option>
<option value="HR"> Croatia </option>
<option value="CU"> Cuba </option>
<option value="CY"> Cyprus </option>
<option value="CZ"> Czech Republic </option>
<option value="DK"> Denmark </option>
<option value="DJ"> Djibouti </option>
<option value="DM"> Dominica </option>
<option value="DO"> Dominican Republic </option>
<option value="EC"> Ecuador </option>
<option value="EG"> Egypt </option>
<option value="SV"> El Salvador </option>
<option value="GQ"> Equatorial Guinea </option>
<option value="ER"> Eritrea </option>
<option value="EE"> Estonia </option>
<option value="ET"> Ethiopia </option>
<option value="FK"> Falkland Islands (malvinas) </option>
<option value="FO"> Faroe Islands </option>
<option value="FJ"> Fiji </option>
<option value="FI"> Finland </option>
<option value="FR"> France </option>
<option value="GF"> French Guiana </option>
<option value="PF"> French Polynesia </option>
<option value="TF"> French Southern Territories </option>
<option value="GA"> Gabon </option>
<option value="GM"> Gambia </option>
<option value="GE"> Georgia </option>
<option value="DE"> Germany </option>
<option value="GH"> Ghana </option>
<option value="GI"> Gibraltar </option>
<option value="GR"> Greece </option>
<option value="GL"> Greenland </option>
<option value="GD"> Grenada </option>
<option value="GP"> Guadeloupe </option>
<option value="GU"> Guam </option>
<option value="GT"> Guatemala </option>
<option value="GG"> Guernsey </option>
<option value="GN"> Guinea </option>
<option value="GW"> Guinea-bissau </option>
<option value="GY"> Guyana </option>
<option value="HT"> Haiti </option>
<option value="HM"> Heard Island & Mcdonald Islands </option>
<option value="VA"> Holy See (vatican City State) </option>
<option value="HN"> Honduras </option>
<option value="HK"> Hong Kong </option>
<option value="HU"> Hungary </option>
<option value="IS"> Iceland </option>
<option value="IN"> India </option>
<option value="ID"> Indonesia </option>
<option value="IR"> Iran, Islamic Republic Of </option>
<option value="IQ"> Iraq </option>
<option value="IE"> Ireland </option>
<option value="IM"> Isle Of Man </option>
<option value="IL"> Israel </option>
<option value="IT"> Italy </option>
<option value="JM"> Jamaica </option>
<option value="JP"> Japan </option>
<option value="JE"> Jersey </option>
<option value="JO"> Jordan </option>
<option value="KZ"> Kazakhstan </option>
<option value="KE"> Kenya </option>
<option value="KI"> Kiribati </option>
<option value="KR"> Korea </option>
<option value="KW"> Kuwait </option>
<option value="KG"> Kyrgyzstan </option>
<option value="LA"> Lao People's Democratic Republic </option>
<option value="LV"> Latvia </option>
<option value="LB"> Lebanon </option>
<option value="LS"> Lesotho </option>
<option value="LR"> Liberia </option>
<option value="LY"> Libyan Arab Jamahiriya </option>
<option value="LI"> Liechtenstein </option>
<option value="LT"> Lithuania </option>
<option value="LU"> Luxembourg </option>
<option value="MO"> Macao </option>
<option value="MK"> Macedonia </option>
<option value="MG"> Madagascar </option>
<option value="MW"> Malawi </option>
<option value="MY"> Malaysia </option>
<option value="MV"> Maldives </option>
<option value="ML"> Mali </option>
<option value="MT"> Malta </option>
<option value="MH"> Marshall Islands </option>
<option value="MQ"> Martinique </option>
<option value="MR"> Mauritania </option>
<option value="MU"> Mauritius </option>
<option value="YT"> Mayotte </option>
<option value="FM"> Micronesia, Federated States Of </option>
<option value="MD"> Moldova </option>
<option value="MC"> Monaco </option>
<option value="MN"> Mongolia </option>
<option value="ME"> Montenegro </option>
<option value="MS"> Montserrat </option>
<option value="MA"> Morocco </option>
<option value="MZ"> Mozambique </option>
<option value="MM"> Myanmar </option>
<option value="NA"> Namibia </option>
<option value="NR"> Nauru </option>
<option value="NP"> Nepal </option>
<option value="NL"> Netherlands </option>
<option value="AN"> Netherlands Antilles </option>
<option value="NC"> New Caledonia </option>
<option value="NZ"> New Zealand </option>
<option value="NI"> Nicaragua </option>
<option value="NE"> Niger </option>
<option value="NG"> Nigeria </option>
<option value="NU"> Niue </option>
<option value="NF"> Norfolk Island </option>
<option value="MP"> Northern Mariana Islands </option>
<option value="NO"> Norway </option>
<option value="OM"> Oman </option>
<option value="PK"> Pakistan </option>
<option value="PW"> Palau </option>
<option value="PS"> Palestinian Territory, Occupied </option>
<option value="PA"> Panama </option>
<option value="PG"> Papua New Guinea </option>
<option value="PY"> Paraguay </option>
<option value="PE"> Peru </option>
<option value="PH"> Philippines </option>
<option value="PN"> Pitcairn </option>
<option value="PL"> Poland </option>
<option value="PT"> Portugal </option>
<option value="PR"> Puerto Rico </option>
<option value="QA"> Qatar </option>
<option value="RE"> Reunion </option>
<option value="RO"> Romania </option>
<option value="RU"> Russian Federation </option>
<option value="RW"> Rwanda </option>
<option value="BL"> Saint Barthelemy </option>
<option value="SH"> Saint Helena </option>
<option value="KN"> Saint Kitts And Nevis </option>
<option value="LC"> Saint Lucia </option>
<option value="MF"> Saint Martin </option>
<option value="PM"> Saint Pierre And Miquelon </option>
<option value="VC"> Saint Vincent And Grenadines </option>
<option value="WS"> Samoa </option>
<option value="SM"> San Marino </option>
<option value="ST"> Sao Tome And Principe </option>
<option value="SA"> Saudi Arabia </option>
<option value="SN"> Senegal </option>
<option value="RS"> Serbia </option>
<option value="SC"> Seychelles </option>
<option value="SL"> Sierra Leone </option>
<option value="SG"> Singapore </option>
<option value="SK"> Slovakia </option>
<option value="SI"> Slovenia </option>
<option value="SB"> Solomon Islands </option>
<option value="SO"> Somalia </option>
<option value="ZA"> South Africa </option>
<option value="GS"> South Georgia And Sandwich Isl. </option>
<option value="ES"> Spain </option>
<option value="LK"> Sri Lanka </option>
<option value="SD"> Sudan </option>
<option value="SR"> Suriname </option>
<option value="SJ"> Svalbard And Jan Mayen </option>
<option value="SZ"> Swaziland </option>
<option value="SE"> Sweden </option>
<option value="CH"> Switzerland </option>
<option value="SY"> Syrian Arab Republic </option>
<option value="TW"> Taiwan </option>
<option value="TJ"> Tajikistan </option>
<option value="TZ"> Tanzania </option>
<option value="TH"> Thailand </option>
<option value="TL"> Timor-leste </option>
<option value="TG"> Togo </option>
<option value="TK"> Tokelau </option>
<option value="TO"> Tonga </option>
<option value="TT"> Trinidad And Tobago </option>
<option value="TN"> Tunisia </option>
<option value="TR"> Turkey </option>
<option value="TM"> Turkmenistan </option>
<option value="TC"> Turks And Caicos Islands </option>
<option value="TV"> Tuvalu </option>
<option value="UG"> Uganda </option>
<option value="UA"> Ukraine </option>
<option value="AE"> United Arab Emirates </option>
<option value="GB"> United Kingdom </option>
<option value="UM"> United States Outlying Islands </option>
<option value="UY"> Uruguay </option>
<option value="UZ"> Uzbekistan </option>
<option value="VU"> Vanuatu </option>
<option value="VE"> Venezuela </option>
<option value="VN"> Viet Nam </option>
<option value="VG"> Virgin Islands, British </option>
<option value="VI"> Virgin Islands, U.s. </option>
<option value="WF"> Wallis And Futuna </option>
<option value="EH"> Western Sahara </option>
<option value="YE"> Yemen </option>
<option value="ZM"> Zambia </option>
<option value="ZW"> Zimbabwe </option>
</select>
</div>
</div>
<div class="form-group row">
<label for="previous-line-1" class="col-sm-4 col-form-label">Previous Address Line 1</label>
<div class="col-sm-8">
<input type="text" class="form-control required" id="previous-line-1" name="previous_line_1" value="">
</div>
</div>
<div class="form-group row">
<label for="previous-line-2" class="col-sm-4 col-form-label">Previous Address Line 2 <span class="text-muted">(Apartment, Unit, Suite, Etc.)</span></label>
<div class="col-sm-8">
<input type="text" class="form-control" id="previous-line-2" name="previous_line_2" value="">
</div>
</div>
<div class="form-group row">
<label for="previous-city" class="col-sm-4 col-form-label">Previous City</label>
<div class="col-sm-8">
<input type="text" class="form-control required" id="previous-city" name="previous_city" value="">
</div>
</div>
<div class="form-group row previous-state-field" style="display:none;">
<label for="previous-state" class="col-sm-4 col-form-label">Previous State</label>
<div class="col-sm-8">
<select class="form-control" id="previous-state" name="previous_state" data-old="">
<option value="" disabled="" selected="">Select state</option>
</select>
</div>
</div>
<div class="form-group row previous-state-other-field" style="display:none;">
<label for="previous-state-other" class="col-sm-4 col-form-label">Previous State</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="previous-state-other" name="previous_state_other" value="">
</div>
</div>
<div class="form-group row">
<label for="previous-zip-code" class="col-sm-4 col-form-label">Previous Zip Code</label>
<div class="col-sm-8">
<input type="text" class="form-control required" id="previous-zip-code" name="previous_zip_code" maxlength="5" pattern="[0-9]{5}" title="Zip code should contain only 5 numbers. Please do not enter any letters." value="">
</div>
</div>
</div>
</div>
</div>
<div class="card mt-3">
<div class="card-header">
<h5 class="mb-0">Criminal History</h5>
</div>
<div class="card-body">
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-8 col-form-label">Excluding juvenile cases unless convicted as an adult, have you been convicted, pled guilty including "no contest", or found not guilty by reason of insanity, of any disqualifying felony listed in TSA
Eligibility Requirements, Part A, in any jurisdiction, military or civilian?</legend>
<div class="col-sm-4">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="part_a_requirements" id="part-a-requirements-no" value="0" required="">
<label class="form-check-label" for="part-a-requirements-no"> No </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="part_a_requirements" id="part-a-requirements-yes" value="1" required="">
<label class="form-check-label" for="part-a-requirements-yes"> Yes </label>
</div>
</div>
</div>
</fieldset>
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-8 col-form-label">Excluding juvenile cases unless convicted as an adult, have you been convicted, pled guilty including "no contest", or found not guilty by reason of insanity, of any disqualifying felony listed in TSA
Eligibility Requirements, Part B, in any jurisdiction, military or civilian, during the 7 years before the date of this application?</legend>
<div class="col-sm-4">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="part_b_requirements" id="part-b-requirements-no" value="0" required="">
<label class="form-check-label" for="part-b-requirements-no"> No </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="part_b_requirements" id="part-b-requirements-yes" value="1" required="">
<label class="form-check-label" for="part-b-requirements-yes"> Yes </label>
</div>
</div>
</div>
</fieldset>
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-8 col-form-label">Have you been released from incarceration in any jurisdiction, military or civilian, for committing any disqualifying felony listed in TSA Eligibility Requirements, Part B, during the 5 years before
the date of this application?</legend>
<div class="col-sm-4">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="part_b_last_5_years" id="part-b-last-5-years-no" value="0" required="">
<label class="form-check-label" for="part-b-last-5-years-no"> No </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="part_b_last_5_years" id="part-b-last-5-years-yes" value="1" required="">
<label class="form-check-label" for="part-b-last-5-years-yes"> Yes </label>
</div>
</div>
</div>
</fieldset>
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-8 col-form-label">Are you wanted or under indictment for any disqualifying crime listed in TSA Eligibility Requirements, Parts A or B?</legend>
<div class="col-sm-4">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="part_a_or_b_wanted" id="part-a-or-b-wanted-no" value="0" required="">
<label class="form-check-label" for="part-a-or-b-wanted-no"> No </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="part_a_or_b_wanted" id="part-a-or-b-wanted-yes" value="1" required="">
<label class="form-check-label" for="part-a-or-b-wanted-yes"> Yes </label>
</div>
</div>
</div>
</fieldset>
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-8 col-form-label">Have you ever been found by a court or other lawful authority as lacking mental capacity or involuntarily committed to a mental institution?</legend>
<div class="col-sm-4">
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="mental_capacity" id="mental-capacity-no" value="0" required="">
<label class="form-check-label" for="mental-capacity-no"> No </label>
</div>
<div class="form-check-inline">
<input class="form-check-input" type="radio" name="mental_capacity" id="mental-capacity-yes" value="1" required="">
<label class="form-check-label" for="mental-capacity-yes"> Yes </label>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="card mt-3 documents" style="display: none;">
<div class="card-header">
<h5 class="mb-0">Documents</h5>
<p class="mb-0 text-muted">Select documents that you will bring to your interview</p>
</div>
<div class="card-body">
<div class="form-group row">
<label for="photo-id" class="col-sm-4 col-form-label">Photo ID Document (Must match your current legal name)</label>
<div class="col-sm-8">
<select class="form-control required" id="photo-id" name="photo_id" data-old="" required="">
<option value="" disabled="" selected="">Select photo ID document</option>
</select>
</div>
</div>
<div class="form-group row citizen-immigration-document-field" style="display:none;">
<label for="citizen-immigration-document" class="col-sm-4 col-form-label">Citizen/Immigration Document</label>
<div class="col-sm-8">
<select class="form-control" id="citizen-immigration-document" name="citizen_immigration_document" data-old="">
<option value="" disabled="" selected="">Select citizen/immigration document</option>
</select>
</div>
</div>
<fieldset class="form-group">
<div class="row">
<legend class="col-sm-8 col-form-label">Do the names (first, middle, last) on your identity documents match (For example driver's license and birth certificate)?</legend>
<div class="col-sm-4">
<div class="form-check-inline">
<input class="form-check-input required" type="radio" name="names_documents_match" id="names-documents-match-yes" value="1" required="" checked=""checked"">
<label class="form-check-label" for="names-documents-match-yes"> Yes </label>
</div>
<div class="form-check-inline">
<input class="form-check-input required" type="radio" name="names_documents_match" id="names-documents-match-no" value="0" required="">
<label class="form-check-label" for="names-documents-match-no"> No </label>
</div>
</div>
</div>
</fieldset>
<div class="form-group row names-match" style="display: none;">
<label for="number-documents-name" class="col-sm-8 col-form-label">How many documents are you providing to prove your current legal name?</label>
<div class="col-sm-4">
<select class="form-control" id="number-documents-name" name="number_documents_name">
<option value="" disabled="" selected="">Select number of documents</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
</select>
</div>
</div>
</div>
</div>
<div class="card mt-3 interview-preferences">
<div class="card-header">
<h5 class="mb-0">Interview Preferences</h5>
</div>
<div class="card-body">
<div class="form-group row">
<label for="desired-interview-location" class="col-sm-8 col-form-label"> Enter Zip Code for Interview Location <br><span class="text-muted">(We will use this zip code to locate the nearest location for your interview)</span></label>
<div class="col-sm-4">
<input type="text" class="form-control required" id="desired-interview-location" maxlength="5" name="desired_interview_location" value="" required="">
</div>
</div>
<div class="form-group row">
<label for="desired-interview-date" class="col-sm-8 col-form-label"> On what date would you like to have your interview scheduled? <br><span class="text-muted">(We will try our best to accommodate your needs, but in case of unavailability, we
will select the date closest to your preference. You can re-schedule your interview later if needed.)</span>
</label>
<div class="col-sm-4">
<input type="text" class="form-control required flatpickr-input" id="desired-interview-date" name="desired_interview_date" value="" required="" readonly="readonly">
</div>
</div>
<div class="form-group row">
<label for="desired-interview-time" class="col-sm-8 col-form-label"> During what time would you prefer to have your interview scheduled? <br><span class="text-muted">(We will try our best to accommodate your needs, but in case of
unavailability, we will select the time closest to your preference. You can re-schedule your interview later if needed.)</span>
</label>
<div class="col-sm-4">
<select class="form-control required" id="desired-interview-time" name="desired_interview_time" required="">
<option value="" disabled="" selected="">Select timeframe</option>
<option value="morning">Morning</option>
<option value="noon">Noon</option>
<option value="afternoon">Afternoon</option>
</select>
</div>
</div>
</div>
</div>
<div class="card mt-3">
<div class="card-header">
<h5 class="mb-0">Agreement</h5>
</div>
<div class="card-body">
<div class="form-group row">
<div class="form-check" style="padding-left: 30px;">
<input class="form-check-input" type="checkbox" value="1" name="agreement" id="agreement" required="">
<label class="form-check-label" for="agreement">
<span class="font-weight-bold text-danger agreement-validation" style="display:none;">Required: Please accept agreement. </span> By checking this box, I am electronically signing to authorize pretsa-pass-us.com to use the information I
provided on this form to apply for TSA Pre-Check for me. I agree to receive sms, email and calls about my order and to the privacy policy and terms and conditions listed on this website. I also affirm the information listed above is
accurate and truthful. I understand that the TSA provides forms and instructions for filings related to TSA Pre-Check on their website for a fee. However, I request to use the pretsa-pass-us.com service to prepare and submit my
application based on the information I have provided. I understand and agree that I will be charged $149.95 for this service in addition to the fee charged by TSA ($85 for New Applications and $70 for Renewals). I also agree to notify the
TSA within 24 hours if I am ever convicted or found not guilty by reason of insanity of any disqualifying crime while I am enrolled in TSA Pre-Check program. pretsa-pass-us.com is a third party company and is not associated with any
government agency. </label>
</div>
</div>
<div class="form-group row">
<label for="phone-number" class="col-sm-4 col-form-label">Phone Number</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="phone-number" name="phone_number" placeholder="XXX-XXX-XXXX" value="" required="">
</div>
</div>
<div class="form-group row">
<label for="country-code" class="col-sm-4 col-form-label">Country Calling Code</label>
<div class="col-sm-8">
<select class="form-control" id="country-code" name="country_code" required="">
<option value="" disabled="" selected="">Select country code</option>
<option value="US"> United States (+1) </option>
<option value="CA"> Canada (+1) </option>
<option value="MX"> Mexico (+52) </option>
<option value="DZ"> Algeria (+213) </option>
<option value="AD"> Andorra (+376) </option>
<option value="AO"> Angola (+244) </option>
<option value="AI"> Anguilla (+1264) </option>
<option value="AG"> Antigua And Barbuda (+1268) </option>
<option value="AR"> Argentina (+54) </option>
<option value="AM"> Armenia (+374) </option>
<option value="AW"> Aruba (+297) </option>
<option value="AU"> Australia (+61) </option>
<option value="AT"> Austria (+43) </option>
<option value="AZ"> Azerbaijan (+994) </option>
<option value="BS"> Bahamas (+1242) </option>
<option value="BH"> Bahrain (+973) </option>
<option value="BD"> Bangladesh (+880) </option>
<option value="BB"> Barbados (+1246) </option>
<option value="BE"> Belgium (+32) </option>
<option value="BZ"> Belize (+501) </option>
<option value="BJ"> Benin (+229) </option>
<option value="BM"> Bermuda (+1441) </option>
<option value="BT"> Bhutan (+975) </option>
<option value="BO"> Bolivia (+591) </option>
<option value="BA"> Bosnia And Herzegovina (+387) </option>
<option value="BW"> Botswana (+267) </option>
<option value="BR"> Brazil (+55) </option>
<option value="BG"> Bulgaria (+359) </option>
<option value="BF"> Burkina Faso (+226) </option>
<option value="KH"> Cambodia (+855) </option>
<option value="CM"> Cameroon (+237) </option>
<option value="KY"> Cayman Islands (+1345) </option>
<option value="CL"> Chile (+56) </option>
<option value="CN"> China (+86) </option>
<option value="CO"> Colombia (+57) </option>
<option value="KM"> Comoros (+269) </option>
<option value="CG"> Congo (+242) </option>
<option value="CK"> Cook Islands (+682) </option>
<option value="CR"> Costa Rica (+506) </option>
<option value="HR"> Croatia (+385) </option>
<option value="CZ"> Czech Republic (+42) </option>
<option value="DK"> Denmark (+45) </option>
<option value="DJ"> Djibouti (+253) </option>
<option value="DM"> Dominica (+1809) </option>
<option value="DO"> Dominican Republic (+1809) </option>
<option value="EC"> Ecuador (+593) </option>
<option value="EG"> Egypt (+20) </option>
<option value="SV"> El Salvador (+503) </option>
<option value="GQ"> Equatorial Guinea (+240) </option>
<option value="ER"> Eritrea (+291) </option>
<option value="EE"> Estonia (+372) </option>
<option value="ET"> Ethiopia (+251) </option>
<option value="FO"> Faroe Islands (+298) </option>
<option value="FJ"> Fiji (+679) </option>
<option value="FI"> Finland (+358) </option>
<option value="FR"> France (+33) </option>
<option value="GF"> French Guiana (+594) </option>
<option value="PF"> French Polynesia (+689) </option>
<option value="GA"> Gabon (+241) </option>
<option value="GM"> Gambia (+220) </option>
<option value="GE"> Georgia (+7880) </option>
<option value="DE"> Germany (+49) </option>
<option value="GH"> Ghana (+233) </option>
<option value="GI"> Gibraltar (+350) </option>
<option value="GR"> Greece (+30) </option>
<option value="GL"> Greenland (+299) </option>
<option value="GD"> Grenada (+1473) </option>
<option value="GP"> Guadeloupe (+590) </option>
<option value="GU"> Guam (+671) </option>
<option value="GT"> Guatemala (+502) </option>
<option value="GN"> Guinea (+224) </option>
<option value="GW"> Guinea-Bissau (+245) </option>
<option value="GY"> Guyana (+592) </option>
<option value="HT"> Haiti (+509) </option>
<option value="VA"> Holy See (Vatican City State) (+379) </option>
<option value="HN"> Honduras (+504) </option>
<option value="HK"> Hong Kong (+852) </option>
<option value="HU"> Hungary (+36) </option>
<option value="IS"> Iceland (+354) </option>
<option value="IN"> India (+91) </option>
<option value="ID"> Indonesia (+62) </option>
<option value="IE"> Ireland (+353) </option>
<option value="IL"> Israel (+972) </option>
<option value="IT"> Italy (+39) </option>
<option value="JM"> Jamaica (+1876) </option>
<option value="JP"> Japan (+81) </option>
<option value="JO"> Jordan (+962) </option>
<option value="KZ"> Kazakhstan (+7) </option>
<option value="KE"> Kenya (+254) </option>
<option value="KI"> Kiribati (+686) </option>
<option value="KW"> Kuwait (+965) </option>
<option value="KG"> Kyrgyzstan (+996) </option>
<option value="LA"> Lao People's Democratic Republic (+856) </option>
<option value="LV"> Latvia (+371) </option>
<option value="LS"> Lesotho (+266) </option>
<option value="LR"> Liberia (+231) </option>
<option value="LI"> Liechtenstein (+417) </option>
<option value="LT"> Lithuania (+370) </option>
<option value="LU"> Luxembourg (+352) </option>
<option value="MO"> Macao (+853) </option>
<option value="MK"> Macedonia (+389) </option>
<option value="MG"> Madagascar (+261) </option>
<option value="MW"> Malawi (+265) </option>
<option value="MY"> Malaysia (+60) </option>
<option value="MV"> Maldives (+960) </option>
<option value="MT"> Malta (+356) </option>
<option value="MH"> Marshall Islands (+692) </option>
<option value="MQ"> Martinique (+596) </option>
<option value="MR"> Mauritania (+222) </option>
<option value="YT"> Mayotte (+269) </option>
<option value="MD"> Moldova (+373) </option>
<option value="MC"> Monaco (+377) </option>
<option value="MN"> Mongolia (+976) </option>
<option value="MS"> Montserrat (+1664) </option>
<option value="MA"> Morocco (+212) </option>
<option value="MZ"> Mozambique (+258) </option>
<option value="MM"> Myanmar (+95) </option>
<option value="NA"> Namibia (+264) </option>
<option value="NR"> Nauru (+674) </option>
<option value="NP"> Nepal (+977) </option>
<option value="NL"> Netherlands (+31) </option>
<option value="NC"> New Caledonia (+687) </option>
<option value="NZ"> New Zealand (+64) </option>
<option value="NE"> Niger (+227) </option>
<option value="NG"> Nigeria (+234) </option>
<option value="NU"> Niue (+683) </option>
<option value="NO"> Norway (+47) </option>
<option value="OM"> Oman (+968) </option>
<option value="PW"> Palau (+680) </option>
<option value="PA"> Panama (+507) </option>
<option value="PG"> Papua New Guinea (+675) </option>
<option value="PY"> Paraguay (+595) </option>
<option value="PE"> Peru (+51) </option>
<option value="PH"> Philippines (+63) </option>
<option value="PL"> Poland (+48) </option>
<option value="PT"> Portugal (+351) </option>
<option value="QA"> Qatar (+974) </option>
<option value="RE"> Reunion (+262) </option>
<option value="RO"> Romania (+40) </option>
<option value="RW"> Rwanda (+250) </option>
<option value="SM"> San Marino (+378) </option>
<option value="ST"> Sao Tome And Principe (+239) </option>
<option value="SA"> Saudi Arabia (+966) </option>
<option value="SN"> Senegal (+221) </option>
<option value="RS"> Serbia (+381) </option>
<option value="SC"> Seychelles (+248) </option>
<option value="SL"> Sierra Leone (+232) </option>
<option value="SG"> Singapore (+65) </option>
<option value="SI"> Slovenia (+386) </option>
<option value="SB"> Solomon Islands (+677) </option>
<option value="ZA"> South Africa (+27) </option>
<option value="ES"> Spain (+34) </option>
<option value="LK"> Sri Lanka (+94) </option>
<option value="SR"> Suriname (+597) </option>
<option value="SZ"> Swaziland (+268) </option>
<option value="SE"> Sweden (+46) </option>
<option value="CH"> Switzerland (+41) </option>
<option value="TW"> Taiwan (+886) </option>
<option value="TH"> Thailand (+66) </option>
<option value="TG"> Togo (+228) </option>
<option value="TO"> Tonga (+676) </option>
<option value="TT"> Trinidad And Tobago (+1868) </option>
<option value="TN"> Tunisia (+216) </option>
<option value="TR"> Turkey (+90) </option>
<option value="TM"> Turkmenistan (+993) </option>
<option value="TC"> Turks And Caicos Islands (+1649) </option>
<option value="TV"> Tuvalu (+688) </option>
<option value="UG"> Uganda (+256) </option>
<option value="AE"> United Arab Emirates (+971) </option>
<option value="GB"> United Kingdom (+44) </option>
<option value="UY"> Uruguay (+598) </option>
<option value="UZ"> Uzbekistan (+7) </option>
<option value="VU"> Vanuatu (+678) </option>
<option value="VN"> Viet Nam (+84) </option>
<option value="VG"> Virgin Islands, British (+1284) </option>
<option value="VI"> Virgin Islands, U.S. (+1340) </option>
<option value="WF"> Wallis And Futuna (+681) </option>
<option value="ZM"> Zambia (+260) </option>
</select>
</div>
</div>
<div class="form-group row">
<label for="email" class="col-sm-4 col-form-label">Email</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="email" name="email" value="" required="">
</div>
</div>
<div class="form-group row">
<label for="email-confirmation" class="col-sm-4 col-form-label">Re-enter Email</label>
<div class="col-sm-8">
<input type="text" class="form-control" id="email-confirmation" name="email_confirmation" value="" required="">
</div>
</div>
<div class="form-group row">
<label for="preferred-contact-method" class="col-sm-4 col-form-label">Preferred Contact Method</label>
<div class="col-sm-8">
<select class="form-control" id="preferred-contact-method" name="preferred_contact_method" required="">
<option value="" disabled="" selected="">Select method</option>
<option value="email">Email</option>
<option value="phone">Phone</option>
</select>
</div>
</div>
<div class="form-group row">
<label for="preferred-language" class="col-sm-4 col-form-label">Preferred Language</label>
<div class="col-sm-8">
<select class="form-control" id="preferred-language" name="preferred_language" required="">
<option value="" disabled="" selected="">Select language</option>
<option value="english">English</option>
<option value="spanish">Spanish</option>
</select>
</div>
</div>
<div class="form-group row mt-5">
<div class="col-sm-12">
<button type="submit" class="btn btn-primary">Submit Application</button>
</div>
</div>
</div>
</div>
</form>Text Content
Pre TSA Pass US SERVICE TYPE Select Service TSA Pre-Check - New Application TSA Pre-Check - Renewal TSA Pre-Check - Child New Application (13+) TSA Pre-Check - Child Renewal (13+) Known Traveler Number (KTN) Confirm Known Traveler Number (KTN) APPLICANT'S BASIC INFORMATION Gender Male Female First Name Middle Name (Optional) Last Name Suffix (Optional) Select one Junior Senior First Second Third Fourth Fifth Sixth Seventh Eighth Ninth Have you used a maiden or different name before? No Yes Previous First Name Previous Middle Name (Optional) Previous Last Name Previous Suffix (Optional) Select one Junior Senior First Second Third Fourth Fifth Sixth Seventh Eighth Ninth Have you ever used an alias for your name before? No Yes Alias First Name Alias Middle Name (Optional) Alias Last Name Alias Suffix (Optional) Select one Junior Senior First Second Third Fourth Fifth Sixth Seventh Eighth Ninth Eye Color Select eye color Black Blue Brown Gray Green Hazel Maroon Multicolored Pink Unknown Hair Color Select hair color Bald Black Blond or Strawberry Brown Gray or Partially Gray Red or Auburn Sandy White Blue Green Orange Pink Purple Unknown Height Select height ft 1 2 3 4 5 6 7 8 9 Select height in 0 1 2 3 4 5 6 7 8 9 10 11 Weight (lbs.) APPLICANT'S BIRTH INFORMATION Country of Birth Select country United States Canada Mexico Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-bissau Guyana Haiti Heard Island & Mcdonald Islands Holy See (vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic Of Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Micronesia, Federated States Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Martin Saint Pierre And Miquelon Saint Vincent And Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And Sandwich Isl. Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.s. Wallis And Futuna Western Sahara Yemen Zambia Zimbabwe City of Birth State of Birth Select state State of Birth Date of Birth Year 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 APPLICANT'S CITIZENSHIP INFORMATION Are you a US citizen, US National or Lawful Permanent Resident? Yes No Since you are not a US Citizen, US National, or a Lawful US Permanent Resident, you cannot apply for TSA Pre-Check. Country of Citizenship Select country United States Canada Mexico Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-bissau Guyana Haiti Heard Island & Mcdonald Islands Holy See (vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic Of Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Micronesia, Federated States Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Martin Saint Pierre And Miquelon Saint Vincent And Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And Sandwich Isl. Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.s. Wallis And Futuna Western Sahara Yemen Zambia Zimbabwe ADDRESS Country Select country United States Canada Mexico Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Cambodia Cameroon Cape Verde Cayman Islands Chad Chile China Christmas Island Cocos (keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-bissau Guyana Haiti Heard Island & Mcdonald Islands Holy See (vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lesotho Liberia Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Micronesia, Federated States Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Martin Saint Pierre And Miquelon Saint Vincent And Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands South Africa South Georgia And Sandwich Isl. Spain Sri Lanka Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Timor-leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda United Arab Emirates United Kingdom United States Outlying Islands Uruguay Uzbekistan Vanuatu Viet Nam Virgin Islands, British Virgin Islands, U.s. Wallis And Futuna Western Sahara Zambia Address Line 1 Address Line 2 (Apartment, Unit, Suite, Etc.) City State Select state State Zip Code Is your mailing address the same as your residential address? Yes No Residential Country Select country United States Canada Mexico Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-bissau Guyana Haiti Heard Island & Mcdonald Islands Holy See (vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic Of Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Micronesia, Federated States Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Martin Saint Pierre And Miquelon Saint Vincent And Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And Sandwich Isl. Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.s. Wallis And Futuna Western Sahara Yemen Zambia Zimbabwe Residential Address Line 1 Residential Address Line 2 (Apartment, Unit, Suite, Etc.) Residential City Residential State Select state Residential State Residential Zip Code Have you lived at your current address for more than 5 years? Yes No Previous Country Select country United States Canada Mexico Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-bissau Guyana Haiti Heard Island & Mcdonald Islands Holy See (vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic Of Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Micronesia, Federated States Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Martin Saint Pierre And Miquelon Saint Vincent And Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And Sandwich Isl. Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.s. Wallis And Futuna Western Sahara Yemen Zambia Zimbabwe Previous Address Line 1 Previous Address Line 2 (Apartment, Unit, Suite, Etc.) Previous City Previous State Select state Previous State Previous Zip Code CRIMINAL HISTORY Excluding juvenile cases unless convicted as an adult, have you been convicted, pled guilty including "no contest", or found not guilty by reason of insanity, of any disqualifying felony listed in TSA Eligibility Requirements, Part A, in any jurisdiction, military or civilian? No Yes Excluding juvenile cases unless convicted as an adult, have you been convicted, pled guilty including "no contest", or found not guilty by reason of insanity, of any disqualifying felony listed in TSA Eligibility Requirements, Part B, in any jurisdiction, military or civilian, during the 7 years before the date of this application? No Yes Have you been released from incarceration in any jurisdiction, military or civilian, for committing any disqualifying felony listed in TSA Eligibility Requirements, Part B, during the 5 years before the date of this application? No Yes Are you wanted or under indictment for any disqualifying crime listed in TSA Eligibility Requirements, Parts A or B? No Yes Have you ever been found by a court or other lawful authority as lacking mental capacity or involuntarily committed to a mental institution? No Yes DOCUMENTS Select documents that you will bring to your interview Photo ID Document (Must match your current legal name) Select photo ID document Citizen/Immigration Document Select citizen/immigration document Do the names (first, middle, last) on your identity documents match (For example driver's license and birth certificate)? Yes No How many documents are you providing to prove your current legal name? Select number of documents 1 2 3 INTERVIEW PREFERENCES Enter Zip Code for Interview Location (We will use this zip code to locate the nearest location for your interview) On what date would you like to have your interview scheduled? (We will try our best to accommodate your needs, but in case of unavailability, we will select the date closest to your preference. You can re-schedule your interview later if needed.) During what time would you prefer to have your interview scheduled? (We will try our best to accommodate your needs, but in case of unavailability, we will select the time closest to your preference. You can re-schedule your interview later if needed.) Select timeframe Morning Noon Afternoon AGREEMENT Required: Please accept agreement. By checking this box, I am electronically signing to authorize pretsa-pass-us.com to use the information I provided on this form to apply for TSA Pre-Check for me. I agree to receive sms, email and calls about my order and to the privacy policy and terms and conditions listed on this website. I also affirm the information listed above is accurate and truthful. I understand that the TSA provides forms and instructions for filings related to TSA Pre-Check on their website for a fee. However, I request to use the pretsa-pass-us.com service to prepare and submit my application based on the information I have provided. I understand and agree that I will be charged $149.95 for this service in addition to the fee charged by TSA ($85 for New Applications and $70 for Renewals). I also agree to notify the TSA within 24 hours if I am ever convicted or found not guilty by reason of insanity of any disqualifying crime while I am enrolled in TSA Pre-Check program. pretsa-pass-us.com is a third party company and is not associated with any government agency. Phone Number Country Calling Code Select country code United States (+1) Canada (+1) Mexico (+52) Algeria (+213) Andorra (+376) Angola (+244) Anguilla (+1264) Antigua And Barbuda (+1268) Argentina (+54) Armenia (+374) Aruba (+297) Australia (+61) Austria (+43) Azerbaijan (+994) Bahamas (+1242) Bahrain (+973) Bangladesh (+880) Barbados (+1246) Belgium (+32) Belize (+501) Benin (+229) Bermuda (+1441) Bhutan (+975) Bolivia (+591) Bosnia And Herzegovina (+387) Botswana (+267) Brazil (+55) Bulgaria (+359) Burkina Faso (+226) Cambodia (+855) Cameroon (+237) Cayman Islands (+1345) Chile (+56) China (+86) Colombia (+57) Comoros (+269) Congo (+242) Cook Islands (+682) Costa Rica (+506) Croatia (+385) Czech Republic (+42) Denmark (+45) Djibouti (+253) Dominica (+1809) Dominican Republic (+1809) Ecuador (+593) Egypt (+20) El Salvador (+503) Equatorial Guinea (+240) Eritrea (+291) Estonia (+372) Ethiopia (+251) Faroe Islands (+298) Fiji (+679) Finland (+358) France (+33) French Guiana (+594) French Polynesia (+689) Gabon (+241) Gambia (+220) Georgia (+7880) Germany (+49) Ghana (+233) Gibraltar (+350) Greece (+30) Greenland (+299) Grenada (+1473) Guadeloupe (+590) Guam (+671) Guatemala (+502) Guinea (+224) Guinea-Bissau (+245) Guyana (+592) Haiti (+509) Holy See (Vatican City State) (+379) Honduras (+504) Hong Kong (+852) Hungary (+36) Iceland (+354) India (+91) Indonesia (+62) Ireland (+353) Israel (+972) Italy (+39) Jamaica (+1876) Japan (+81) Jordan (+962) Kazakhstan (+7) Kenya (+254) Kiribati (+686) Kuwait (+965) Kyrgyzstan (+996) Lao People's Democratic Republic (+856) Latvia (+371) Lesotho (+266) Liberia (+231) Liechtenstein (+417) Lithuania (+370) Luxembourg (+352) Macao (+853) Macedonia (+389) Madagascar (+261) Malawi (+265) Malaysia (+60) Maldives (+960) Malta (+356) Marshall Islands (+692) Martinique (+596) Mauritania (+222) Mayotte (+269) Moldova (+373) Monaco (+377) Mongolia (+976) Montserrat (+1664) Morocco (+212) Mozambique (+258) Myanmar (+95) Namibia (+264) Nauru (+674) Nepal (+977) Netherlands (+31) New Caledonia (+687) New Zealand (+64) Niger (+227) Nigeria (+234) Niue (+683) Norway (+47) Oman (+968) Palau (+680) Panama (+507) Papua New Guinea (+675) Paraguay (+595) Peru (+51) Philippines (+63) Poland (+48) Portugal (+351) Qatar (+974) Reunion (+262) Romania (+40) Rwanda (+250) San Marino (+378) Sao Tome And Principe (+239) Saudi Arabia (+966) Senegal (+221) Serbia (+381) Seychelles (+248) Sierra Leone (+232) Singapore (+65) Slovenia (+386) Solomon Islands (+677) South Africa (+27) Spain (+34) Sri Lanka (+94) Suriname (+597) Swaziland (+268) Sweden (+46) Switzerland (+41) Taiwan (+886) Thailand (+66) Togo (+228) Tonga (+676) Trinidad And Tobago (+1868) Tunisia (+216) Turkey (+90) Turkmenistan (+993) Turks And Caicos Islands (+1649) Tuvalu (+688) Uganda (+256) United Arab Emirates (+971) United Kingdom (+44) Uruguay (+598) Uzbekistan (+7) Vanuatu (+678) Viet Nam (+84) Virgin Islands, British (+1284) Virgin Islands, U.S. (+1340) Wallis And Futuna (+681) Zambia (+260) Email Re-enter Email Preferred Contact Method Select method Email Phone Preferred Language Select language English Spanish Submit Application MayJuneJulyAugustSeptemberOctoberNovemberDecember SunMonTueWedThuFriSat 301234567891011121314151617181920212223242526272829303112345678910