<HTML> <HEAD> <META http-equiv="Content-Type" content="text/html; charset=utf-16" /> <TITLE>TLC Worldwide mailing list</TITLE> </HEAD> <BODY BGCOLOR="#ffffff" TEXT="#000000"> <SCRIPT SRC="tlc_app_form_men.js"> </SCRIPT> <form method="post" action="/cgi-bin/soupermail.pl" ENCTYPE="multipart/form-data" name="tlc" onSubmit="return validateForm(tlc)"> <DIV ALIGN="CENTER"> <TABLE CELLPADDING="0" CELLSPACING="0" BORDER="0"> <TR> <INPUT TYPE="HIDDEN" NAME="msgnum" VALUE="" /> <TD COLSPAN="5" ALIGN="LEFT"> <TABLE WIDTH="100%" CELLPADDING="0" CELLSPACING="0" BORDER="0"> <TR> <TD> <FONT FACE="arial, helvetica" SIZE="-1"> <STRONG>Join the TLC Worldwide mailing list</STRONG> </FONT> </TD> <TD VALIGN="BOTTOM" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#333333"> Powered by TLC Worldwide </FONT> </TD> </TR> </TABLE> </TD> </TR> <TR> <TD COLSPAN="5" BGCOLOR="#C7C7C7" WIDTH="1" HEIGHT="1"> <BR /> </TD> </TR> <TR> <TD COLSPAN="5" VALIGN="TOP"> <TABLE WIDTH="100%" CELLPADDING="0" CELLSPACING="2" BORDER="0"> <TR> <TD COLSPAN="2"> <FONT FACE="arial, helvetica" SIZE="-1" COLOR="#006600"> <STRONG> Please tell us</STRONG> </FONT> </TD> </TR> <TR> <TD WIDTH="60%" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> Your e-mail address  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required)</FONT>:  <INPUT TYPE="text" NAME="email" MAXLENGTH="127" SIZE="30" VALUE="" STYLE="font size:9pt" /></FONT> </TD> </TR> <TR> <TD WIDTH="60%" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> Retype your e-mail address  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required)</FONT>:  <INPUT TYPE="text" NAME="email2" MAXLENGTH="127" SIZE="30" VALUE="" STYLE="font size:9pt" /></FONT> </TD> </TR> </TABLE> </TD> </TR> <TR> <TD COLSPAN="5" BGCOLOR="#C7C7C7" WIDTH="1" HEIGHT="1"> <BR /> </TD> </TR> <TR> <TD WIDTH="40%" VALIGN="TOP"> <TABLE WIDTH="100%" CELLPADDING="2" CELLSPACING="0" BORDER="0"> <TR> <TD COLSPAN="2" VALIGN="TOP"> <FONT SIZE="-1" FACE="arial, helvetica" COLOR="#006600"> <STRONG> Select your interests</STRONG> </FONT> <BR /> </TD> </TR> <TR> <TD VALIGN="TOP"> <INPUT TYPE="checkbox" NAME="INTEREST56971" VALUE="1" /> <FONT FACE="arial, helvetica" SIZE="-1">TLC Worldwide, Inc. (Meet Single Latin women)</FONT> </TD> </TR> <TR> <TD VALIGN="TOP"> <INPUT TYPE="checkbox" NAME="INTEREST56989" VALUE="1" /> <FONT FACE="arial, helvetica" SIZE="-1">Singles Vacations to meet Latin Women info</FONT> </TD> </TR> <TR> <TD VALIGN="TOP"> <INPUT TYPE="checkbox" NAME="INTEREST205217" VALUE="1" /> <FONT FACE="arial, helvetica" SIZE="-1">FREE Brochures of 140 Latin women </FONT> </TD> </TR> <TR> <TD VALIGN="TOP"> <INPUT TYPE="checkbox" NAME="INTEREST205219" VALUE="1" /> <FONT FACE="arial, helvetica" SIZE="-1">Call us at 713-896-9993 for a free consultation.</FONT> </TD> </TR> </TABLE> </TD> <TD WIDTH="5"> <IMG SRC="/images/bump.gif" WIDTH="5" HEIGHT="1" /> </TD> <TD WIDTH="1" BGCOLOR="#C7C7C7"> <IMG SRC="/images/bump.gif" WIDTH="1" HEIGHT="1" /> </TD> <TD WIDTH="5"> <IMG SRC="/images/bump.gif" WIDTH="5" HEIGHT="1" /> </TD> <TD VALIGN="TOP"> <TABLE WIDTH="100%" CELLPADDING="0" CELLSPACING="4" BORDER="0"> <TR> <TD COLSPAN="2" VALIGN="TOP"> <FONT FACE="arial, helvetica" SIZE="-1" COLOR="#006600"> <STRONG>We'd like to get to know you</STRONG> </FONT> <BR /> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">First Name</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <INPUT TYPE="TEXT" NAME="RCUSTOM23" MAXLENGTH="255" VALUE="" SIZE="18" STYLE="font size:9pt" /> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">Last Name</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <INPUT TYPE="TEXT" NAME="RCUSTOM24" MAXLENGTH="255" VALUE="" SIZE="18" STYLE="font size:9pt" /> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">Age</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <SELECT STYLE="font size:9pt" name="RCUSTOM25"> <OPTION VALUE="" SELECTED> please select one</OPTION> <OPTION VALUE="under 18">under 18</OPTION> <OPTION VALUE="18-25">18-25</OPTION> <OPTION VALUE="26-29">26-29</OPTION> <OPTION VALUE="30-39">30-39</OPTION> <OPTION VALUE="40-49">40-49</OPTION> <OPTION VALUE="50-59">50-59</OPTION> <OPTION VALUE="60 or over">60 or over</OPTION> </SELECT> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">Gender</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <INPUT TYPE="RADIO" NAME="RCUSTOM26" VALUE="female" />female<BR /><INPUT TYPE="RADIO" NAME="RCUSTOM26" VALUE="male" />male<BR /></FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">Education</FONT>  </TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <SELECT STYLE="font size:9pt" name="CUSTOM27"> <OPTION VALUE="" SELECTED> please select one</OPTION> <OPTION VALUE="grammar/middle school">grammar/middle school</OPTION> <OPTION VALUE="high school diploma">high school diploma</OPTION> <OPTION VALUE="some college">some college</OPTION> <OPTION VALUE="bachelor's degree">bachelor's degree</OPTION> <OPTION VALUE="graduate degree">graduate degree</OPTION> </SELECT> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">Marital Status</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <SELECT STYLE="font size:9pt" name="RCUSTOM28"> <OPTION VALUE="" SELECTED> please select one</OPTION> <OPTION VALUE="single">single</OPTION> <OPTION VALUE="married">married</OPTION> <OPTION VALUE="divorced">divorced</OPTION> <OPTION VALUE="other">other</OPTION> </SELECT> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">Address</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <INPUT TYPE="TEXT" NAME="RCUSTOM30" MAXLENGTH="255" VALUE="" SIZE="18" STYLE="font size:9pt" /> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">City</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <INPUT TYPE="TEXT" NAME="RCUSTOM31" MAXLENGTH="255" VALUE="" SIZE="18" STYLE="font size:9pt" /> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">State or Province</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <SELECT STYLE="font size:9pt" name="RCUSTOM32"> <OPTION VALUE="" SELECTED> please select one</OPTION> <OPTION VALUE="Outside US and Canada">Outside US and Canada</OPTION> <OPTION VALUE="Alabama">Alabama</OPTION> <OPTION VALUE="Alaska">Alaska</OPTION> <OPTION VALUE="Alberta">Alberta</OPTION> <OPTION VALUE="American Samoa">American Samoa</OPTION> <OPTION VALUE="Arizona">Arizona</OPTION> <OPTION VALUE="Arkansas">Arkansas</OPTION> <OPTION VALUE="Armed Forces Americas">Armed Forces Americas</OPTION> <OPTION VALUE="Armed Forces Europe">Armed Forces Europe</OPTION> <OPTION VALUE="Armed Forces Pacific">Armed Forces Pacific</OPTION> <OPTION VALUE="British Columbia">British Columbia</OPTION> <OPTION VALUE="California">California</OPTION> <OPTION VALUE="Colorado">Colorado</OPTION> <OPTION VALUE="Connecticut">Connecticut</OPTION> <OPTION VALUE="Delaware">Delaware</OPTION> <OPTION VALUE="District Of Columbia">District Of Columbia</OPTION> <OPTION VALUE="Florida">Florida</OPTION> <OPTION VALUE="Georgia">Georgia</OPTION> <OPTION VALUE="Guam">Guam</OPTION> <OPTION VALUE="Hawaii">Hawaii</OPTION> <OPTION VALUE="Idaho">Idaho</OPTION> <OPTION VALUE="Illinois">Illinois</OPTION> <OPTION VALUE="Indiana">Indiana</OPTION> <OPTION VALUE="Iowa">Iowa</OPTION> <OPTION VALUE="Kansas">Kansas</OPTION> <OPTION VALUE="Kentucky">Kentucky</OPTION> <OPTION VALUE="Louisiana">Louisiana</OPTION> <OPTION VALUE="Maine">Maine</OPTION> <OPTION VALUE="Manitoba">Manitoba</OPTION> <OPTION VALUE="Maryland">Maryland</OPTION> <OPTION VALUE="Massachusetts">Massachusetts</OPTION> <OPTION VALUE="Michigan">Michigan</OPTION> <OPTION VALUE="Minnesota">Minnesota</OPTION> <OPTION VALUE="Mississippi">Mississippi</OPTION> <OPTION VALUE="Missouri">Missouri</OPTION> <OPTION VALUE="Montana">Montana</OPTION> <OPTION VALUE="Nebraska">Nebraska</OPTION> <OPTION VALUE="Nevada">Nevada</OPTION> <OPTION VALUE="New Brunswick">New Brunswick</OPTION> <OPTION VALUE="New Hampshire">New Hampshire</OPTION> <OPTION VALUE="New Jersey">New Jersey</OPTION> <OPTION VALUE="New Mexico">New Mexico</OPTION> <OPTION VALUE="New York">New York</OPTION> <OPTION VALUE="Newfoundland">Newfoundland</OPTION> <OPTION VALUE="North Carolina">North Carolina</OPTION> <OPTION VALUE="North Dakota">North Dakota</OPTION> <OPTION VALUE="Northern Mariana Is">Northern Mariana Is</OPTION> <OPTION VALUE="Northwest Territories">Northwest Territories</OPTION> <OPTION VALUE="Nova Scotia">Nova Scotia</OPTION> <OPTION VALUE="Ohio">Ohio</OPTION> <OPTION VALUE="Oklahoma">Oklahoma</OPTION> <OPTION VALUE="Ontario">Ontario</OPTION> <OPTION VALUE="Oregon">Oregon</OPTION> <OPTION VALUE="Palau">Palau</OPTION> <OPTION VALUE="Pennsylvania">Pennsylvania</OPTION> <OPTION VALUE="Prince Edward Island">Prince Edward Island</OPTION> <OPTION VALUE="Quebec">Quebec</OPTION> <OPTION VALUE="Puerto Rico">Puerto Rico</OPTION> <OPTION VALUE="Rhode Island">Rhode Island</OPTION> <OPTION VALUE="Saskatchewan">Saskatchewan</OPTION> <OPTION VALUE="South Carolina">South Carolina</OPTION> <OPTION VALUE="South Dakota">South Dakota</OPTION> <OPTION VALUE="Tennessee">Tennessee</OPTION> <OPTION VALUE="Texas">Texas</OPTION> <OPTION VALUE="Utah">Utah</OPTION> <OPTION VALUE="Vermont">Vermont</OPTION> <OPTION VALUE="Virgin Islands">Virgin Islands</OPTION> <OPTION VALUE="Virginia">Virginia</OPTION> <OPTION VALUE="Washington">Washington</OPTION> <OPTION VALUE="West Virginia">West Virginia</OPTION> <OPTION VALUE="Wisconsin">Wisconsin</OPTION> <OPTION VALUE="Wyoming">Wyoming</OPTION> <OPTION VALUE="Yukon Territory">Yukon Territory</OPTION> </SELECT> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">ZIP or Postal Code</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <INPUT TYPE="TEXT" NAME="RCUSTOM33" MAXLENGTH="255" VALUE="" SIZE="18" STYLE="font size:9pt" /> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">Country</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <SELECT STYLE="font size:9pt" name="RCUSTOM34"> <OPTION VALUE="" SELECTED> please select one</OPTION> <OPTION VALUE="United States of America">United States of America</OPTION> <OPTION VALUE="Canada">Canada</OPTION> <OPTION VALUE="Afghanistan">Afghanistan</OPTION> <OPTION VALUE="Albania">Albania</OPTION> <OPTION VALUE="Algeria">Algeria</OPTION> <OPTION VALUE="American Samoa">American Samoa</OPTION> <OPTION VALUE="Andorra">Andorra</OPTION> <OPTION VALUE="Angola">Angola</OPTION> <OPTION VALUE="Anguilla">Anguilla</OPTION> <OPTION VALUE="Antarctica">Antarctica</OPTION> <OPTION VALUE="Antigua and Barbuda">Antigua and Barbuda</OPTION> <OPTION VALUE="Argentina">Argentina</OPTION> <OPTION VALUE="Armenia">Armenia</OPTION> <OPTION VALUE="Aruba">Aruba</OPTION> <OPTION VALUE="Australia">Australia</OPTION> <OPTION VALUE="Austria">Austria</OPTION> <OPTION VALUE="Azerbaijan">Azerbaijan</OPTION> <OPTION VALUE="Bahamas">Bahamas</OPTION> <OPTION VALUE="Bahrain">Bahrain</OPTION> <OPTION VALUE="Bangladesh">Bangladesh</OPTION> <OPTION VALUE="Barbados">Barbados</OPTION> <OPTION VALUE="Belarus">Belarus</OPTION> <OPTION VALUE="Belgium">Belgium</OPTION> <OPTION VALUE="Belize">Belize</OPTION> <OPTION VALUE="Benin">Benin</OPTION> <OPTION VALUE="Bermuda">Bermuda</OPTION> <OPTION VALUE="Bhutan">Bhutan</OPTION> <OPTION VALUE="Bolivia">Bolivia</OPTION> <OPTION VALUE="Bosnia and Herzegowina">Bosnia and Herzegowina</OPTION> <OPTION VALUE="Botswana">Botswana</OPTION> <OPTION VALUE="Bouvet Island">Bouvet Island</OPTION> <OPTION VALUE="Brazil">Brazil</OPTION> <OPTION VALUE="British Indian Ocean Territory">British Indian Ocean Territory</OPTION> <OPTION VALUE="Brunei Darussalam">Brunei Darussalam</OPTION> <OPTION VALUE="Bulgaria">Bulgaria</OPTION> <OPTION VALUE="Burkina Faso">Burkina Faso</OPTION> <OPTION VALUE="Burundi">Burundi</OPTION> <OPTION VALUE="Cambodia">Cambodia</OPTION> <OPTION VALUE="Cameroon">Cameroon</OPTION> <OPTION VALUE="Cape Verde">Cape Verde</OPTION> <OPTION VALUE="Cayman Islands">Cayman Islands</OPTION> <OPTION VALUE="Central African Republic">Central African Republic</OPTION> <OPTION VALUE="Chad">Chad</OPTION> <OPTION VALUE="Chile">Chile</OPTION> <OPTION VALUE="China">China</OPTION> <OPTION VALUE="Christmas Island">Christmas Island</OPTION> <OPTION VALUE="Cocoa (Keeling) Islands">Cocoa (Keeling) Islands</OPTION> <OPTION VALUE="Colombia">Colombia</OPTION> <OPTION VALUE="Comoros">Comoros</OPTION> <OPTION VALUE="Congo">Congo</OPTION> <OPTION VALUE="Cook Islands">Cook Islands</OPTION> <OPTION VALUE="Costa Rica">Costa Rica</OPTION> <OPTION VALUE="Cote Divoire">Cote Divoire</OPTION> <OPTION VALUE="Croatia (local name: Hrvatska)">Croatia (local name: Hrvatska)</OPTION> <OPTION VALUE="Cuba">Cuba</OPTION> <OPTION VALUE="Cyprus">Cyprus</OPTION> <OPTION VALUE="Czech Republic">Czech Republic</OPTION> <OPTION VALUE="Denmark">Denmark</OPTION> <OPTION VALUE="Djibouti">Djibouti</OPTION> <OPTION VALUE="Dominica">Dominica</OPTION> <OPTION VALUE="Dominican Republic">Dominican Republic</OPTION> <OPTION VALUE="East Timor">East Timor</OPTION> <OPTION VALUE="Ecuador">Ecuador</OPTION> <OPTION VALUE="Egypt">Egypt</OPTION> <OPTION VALUE="El Salvador">El Salvador</OPTION> <OPTION VALUE="Equatorial Guinea">Equatorial Guinea</OPTION> <OPTION VALUE="Eritrea">Eritrea</OPTION> <OPTION VALUE="Estonia">Estonia</OPTION> <OPTION VALUE="Ethiopia">Ethiopia</OPTION> <OPTION VALUE="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</OPTION> <OPTION VALUE="Faroe Islands">Faroe Islands</OPTION> <OPTION VALUE="Fiji">Fiji</OPTION> <OPTION VALUE="Finland">Finland</OPTION> <OPTION VALUE="France">France</OPTION> <OPTION VALUE="France, Metropolitan">France, Metropolitan</OPTION> <OPTION VALUE="French Guiana">French Guiana</OPTION> <OPTION VALUE="French Polynesia">French Polynesia</OPTION> <OPTION VALUE="French Southern Territories">French Southern Territories</OPTION> <OPTION VALUE="Gabon">Gabon</OPTION> <OPTION VALUE="Gambia">Gambia</OPTION> <OPTION VALUE="Georgia">Georgia</OPTION> <OPTION VALUE="Germany">Germany</OPTION> <OPTION VALUE="Ghana">Ghana</OPTION> <OPTION VALUE="Gibraltar">Gibraltar</OPTION> <OPTION VALUE="Greece">Greece</OPTION> <OPTION VALUE="Greenland">Greenland</OPTION> <OPTION VALUE="Grenada">Grenada</OPTION> <OPTION VALUE="Guadeloupe">Guadeloupe</OPTION> <OPTION VALUE="Guam">Guam</OPTION> <OPTION VALUE="Guatemala">Guatemala</OPTION> <OPTION VALUE="Guinea">Guinea</OPTION> <OPTION VALUE="Guinea-Bissau">Guinea-Bissau</OPTION> <OPTION VALUE="Guyana">Guyana</OPTION> <OPTION VALUE="Haiti">Haiti</OPTION> <OPTION VALUE="Heard and Mc Donald Islands">Heard and Mc Donald Islands</OPTION> <OPTION VALUE="Honduras">Honduras</OPTION> <OPTION VALUE="Hong Kong">Hong Kong</OPTION> <OPTION VALUE="Hungary">Hungary</OPTION> <OPTION VALUE="Iceland">Iceland</OPTION> <OPTION VALUE="India">India</OPTION> <OPTION VALUE="Indonesia">Indonesia</OPTION> <OPTION VALUE="Iran (Islamic Republic of)">Iran (Islamic Republic of)</OPTION> <OPTION VALUE="Iraq">Iraq</OPTION> <OPTION VALUE="Ireland">Ireland</OPTION> <OPTION VALUE="Israel">Israel</OPTION> <OPTION VALUE="Italy">Italy</OPTION> <OPTION VALUE="Jamaica">Jamaica</OPTION> <OPTION VALUE="Japan">Japan</OPTION> <OPTION VALUE="Jordan">Jordan</OPTION> <OPTION VALUE="Kazakhstan">Kazakhstan</OPTION> <OPTION VALUE="Kenya">Kenya</OPTION> <OPTION VALUE="Kiribati">Kiribati</OPTION> <OPTION VALUE="Korea, Democratic Peoples Republic of">Korea, Democratic Peoples Republic of</OPTION> <OPTION VALUE="Korea, Republic of">Korea, Republic of</OPTION> <OPTION VALUE="Kuwait">Kuwait</OPTION> <OPTION VALUE="Kyrgyzstan">Kyrgyzstan</OPTION> <OPTION VALUE="Lao Peoples Democratic Republic">Lao Peoples Democratic Republic</OPTION> <OPTION VALUE="Latvia">Latvia</OPTION> <OPTION VALUE="Lebanon">Lebanon</OPTION> <OPTION VALUE="Lesotho">Lesotho</OPTION> <OPTION VALUE="Liberia">Liberia</OPTION> <OPTION VALUE="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</OPTION> <OPTION VALUE="Liechtenstein">Liechtenstein</OPTION> <OPTION VALUE="Lithuania">Lithuania</OPTION> <OPTION VALUE="Luxembourg">Luxembourg</OPTION> <OPTION VALUE="Macau">Macau</OPTION> <OPTION VALUE="Macedonia">Macedonia</OPTION> <OPTION VALUE="Madagascar">Madagascar</OPTION> <OPTION VALUE="Malawi">Malawi</OPTION> <OPTION VALUE="Malaysia">Malaysia</OPTION> <OPTION VALUE="Maldives">Maldives</OPTION> <OPTION VALUE="Mali">Mali</OPTION> <OPTION VALUE="Malta">Malta</OPTION> <OPTION VALUE="Marshall Islands">Marshall Islands</OPTION> <OPTION VALUE="Martinique">Martinique</OPTION> <OPTION VALUE="Mauritania">Mauritania</OPTION> <OPTION VALUE="Mauritius">Mauritius</OPTION> <OPTION VALUE="Mayotte">Mayotte</OPTION> <OPTION VALUE="Mexico">Mexico</OPTION> <OPTION VALUE="Micronesia, Federated States Of">Micronesia, Federated States Of</OPTION> <OPTION VALUE="Moldova, Republic of">Moldova, Republic of</OPTION> <OPTION VALUE="Monaco">Monaco</OPTION> <OPTION VALUE="Mongolia">Mongolia</OPTION> <OPTION VALUE="Montserrat">Montserrat</OPTION> <OPTION VALUE="Morocco">Morocco</OPTION> <OPTION VALUE="Mozambique">Mozambique</OPTION> <OPTION VALUE="Myanmar">Myanmar</OPTION> <OPTION VALUE="Namibia">Namibia</OPTION> <OPTION VALUE="Nauru">Nauru</OPTION> <OPTION VALUE="Nepal">Nepal</OPTION> <OPTION VALUE="Netherlands">Netherlands</OPTION> <OPTION VALUE="Netherlands Antilles">Netherlands Antilles</OPTION> <OPTION VALUE="New Caledonia">New Caledonia</OPTION> <OPTION VALUE="New Zealand">New Zealand</OPTION> <OPTION VALUE="Nicaragua">Nicaragua</OPTION> <OPTION VALUE="Niger">Niger</OPTION> <OPTION VALUE="Nigeria">Nigeria</OPTION> <OPTION VALUE="Niue">Niue</OPTION> <OPTION VALUE="Norfolk Island">Norfolk Island</OPTION> <OPTION VALUE="Northern Mariana Islands">Northern Mariana Islands</OPTION> <OPTION VALUE="Norway">Norway</OPTION> <OPTION VALUE="Oman">Oman</OPTION> <OPTION VALUE="Pakistan">Pakistan</OPTION> <OPTION VALUE="Palau">Palau</OPTION> <OPTION VALUE="Panama">Panama</OPTION> <OPTION VALUE="Papua New Guinea">Papua New Guinea</OPTION> <OPTION VALUE="Paraguay">Paraguay</OPTION> <OPTION VALUE="Peru">Peru</OPTION> <OPTION VALUE="Philippines">Philippines</OPTION> <OPTION VALUE="Pitcairn">Pitcairn</OPTION> <OPTION VALUE="Poland">Poland</OPTION> <OPTION VALUE="Portugal">Portugal</OPTION> <OPTION VALUE="Puerto Rico">Puerto Rico</OPTION> <OPTION VALUE="Qatar">Qatar</OPTION> <OPTION VALUE="Reunion">Reunion</OPTION> <OPTION VALUE="Romania">Romania</OPTION> <OPTION VALUE="Russian Federation">Russian Federation</OPTION> <OPTION VALUE="Rwanda">Rwanda</OPTION> <OPTION VALUE="Saint Kitts and Nevis">Saint Kitts and Nevis</OPTION> <OPTION VALUE="Saint Lucia">Saint Lucia</OPTION> <OPTION VALUE="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</OPTION> <OPTION VALUE="Samoa">Samoa</OPTION> <OPTION VALUE="San Marino">San Marino</OPTION> <OPTION VALUE="Sao Tome and Principe">Sao Tome and Principe</OPTION> <OPTION VALUE="Saudi Arabia">Saudi Arabia</OPTION> <OPTION VALUE="Senegal">Senegal</OPTION> <OPTION VALUE="Seychelles">Seychelles</OPTION> <OPTION VALUE="Sierra Leone">Sierra Leone</OPTION> <OPTION VALUE="Singapore">Singapore</OPTION> <OPTION VALUE="Slovakia (Slovak Republic)">Slovakia (Slovak Republic)</OPTION> <OPTION VALUE="Slovenia">Slovenia</OPTION> <OPTION VALUE="Solomon Islands">Solomon Islands</OPTION> <OPTION VALUE="Somalia">Somalia</OPTION> <OPTION VALUE="South Africa">South Africa</OPTION> <OPTION VALUE="South Georgia">South Georgia</OPTION> <OPTION VALUE="Spain">Spain</OPTION> <OPTION VALUE="Sri Lanka">Sri Lanka</OPTION> <OPTION VALUE="St. Helena">St. Helena</OPTION> <OPTION VALUE="St. Pierre and Miquelon">St. Pierre and Miquelon</OPTION> <OPTION VALUE="Sudan">Sudan</OPTION> <OPTION VALUE="Suriname">Suriname</OPTION> <OPTION VALUE="Svalbard and Jan Mayen Islands">Svalbard and Jan Mayen Islands</OPTION> <OPTION VALUE="Swaziland">Swaziland</OPTION> <OPTION VALUE="Sweden">Sweden</OPTION> <OPTION VALUE="Switzerland">Switzerland</OPTION> <OPTION VALUE="Syrian Arab Republic">Syrian Arab Republic</OPTION> <OPTION VALUE="Taiwan">Taiwan</OPTION> <OPTION VALUE="Tajikistan">Tajikistan</OPTION> <OPTION VALUE="Tanzania, United Republic of">Tanzania, United Republic of</OPTION> <OPTION VALUE="Thailand">Thailand</OPTION> <OPTION VALUE="Togo">Togo</OPTION> <OPTION VALUE="Tokelau">Tokelau</OPTION> <OPTION VALUE="Tonga">Tonga</OPTION> <OPTION VALUE="Trinidad and Tobago">Trinidad and Tobago</OPTION> <OPTION VALUE="Tunisia">Tunisia</OPTION> <OPTION VALUE="Turkey">Turkey</OPTION> <OPTION VALUE="Turkmenistan">Turkmenistan</OPTION> <OPTION VALUE="Turks and Caicos Islands">Turks and Caicos Islands</OPTION> <OPTION VALUE="Tuvalu">Tuvalu</OPTION> <OPTION VALUE="Uganda">Uganda</OPTION> <OPTION VALUE="Ukraine">Ukraine</OPTION> <OPTION VALUE="United Arab Emirates">United Arab Emirates</OPTION> <OPTION VALUE="United Kingdom">United Kingdom</OPTION> <OPTION VALUE="United States Minor Outlying Islands">United States Minor Outlying Islands</OPTION> <OPTION VALUE="Uruguay">Uruguay</OPTION> <OPTION VALUE="Uzbekistan">Uzbekistan</OPTION> <OPTION VALUE="Vanuatu">Vanuatu</OPTION> <OPTION VALUE="Vatican City State (Holy See)">Vatican City State (Holy See)</OPTION> <OPTION VALUE="Venezuela">Venezuela</OPTION> <OPTION VALUE="Viet Nam">Viet Nam</OPTION> <OPTION VALUE="Virgin Islands (British)">Virgin Islands (British)</OPTION> <OPTION VALUE="Virgin Islands (U.S.)">Virgin Islands (U.S.)</OPTION> <OPTION VALUE="Wallis and Futuna Islands">Wallis and Futuna Islands</OPTION> <OPTION VALUE="Yemen">Yemen</OPTION> <OPTION VALUE="Yugoslavia">Yugoslavia</OPTION> <OPTION VALUE="Zaire">Zaire</OPTION> <OPTION VALUE="Zambia">Zambia</OPTION> <OPTION VALUE="Zimbabwe">Zimbabwe</OPTION> </SELECT> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">Home Phone</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <INPUT TYPE="TEXT" NAME="RCUSTOM35" MAXLENGTH="255" VALUE="" SIZE="18" STYLE="font size:9pt" /> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">Occupation</FONT>  </TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <SELECT STYLE="font size:9pt" name="CUSTOM36"> <OPTION VALUE="" SELECTED> please select one</OPTION> <OPTION VALUE="accounting/finance">accounting/finance</OPTION> <OPTION VALUE="executive/senior management">executive/senior management</OPTION> <OPTION VALUE="professional/managerial">professional/managerial</OPTION> <OPTION VALUE="technical/engineering">technical/engineering</OPTION> <OPTION VALUE="administrative/secretarial">administrative/secretarial</OPTION> <OPTION VALUE="sales/marketing/advertising">sales/marketing/advertising</OPTION> <OPTION VALUE="customer service/support">customer service/support</OPTION> <OPTION VALUE="college/university faculty">college/university faculty</OPTION> <OPTION VALUE="college/university student">college/university student</OPTION> <OPTION VALUE="k-12 student">k-12 student</OPTION> <OPTION VALUE="writer/journalist">writer/journalist</OPTION> <OPTION VALUE="homemaker">homemaker</OPTION> <OPTION VALUE="retired">retired</OPTION> <OPTION VALUE="currently not employed">currently not employed</OPTION> <OPTION VALUE="other">other</OPTION> </SELECT> </FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="RIGHT"> <FONT FACE="arial, helvetica" SIZE="-1">Mr/Ms</FONT>  <FONT FACE="arial, helvetica" SIZE="-2" COLOR="#FF0000">(required):</FONT></TD> <TD VALIGN="TOP" ALIGN="LEFT"> <FONT FACE="arial, helvetica" SIZE="-1"> <INPUT TYPE="RADIO" NAME="RCUSTOM56972" VALUE="Mr." />Mr.<BR /><INPUT TYPE="RADIO" NAME="RCUSTOM56972" VALUE="Ms." />Ms.<BR /></FONT> </TD> </TR> <TR> <TD VALIGN="TOP" ALIGN="CENTER" > <BR /> <FONT FACE="arial, helvetica" SIZE="-1"> <INPUT TYPE="SUBMIT" value="Submit" /> <BR /> </FONT> </TD> </TR> </TABLE> </TD> </TR> <TR> <TD COLSPAN="5" BGCOLOR="#C7C7C7"> <IMG SRC="/images/bump.gif" WIDTH="1" HEIGHT="1" /> </TD> </TR> <INPUT TYPE="HIDDEN" NAME="customerid" VALUE="13911" /> <INPUT TYPE="HIDDEN" NAME="fromurl" VALUE="" /> <INPUT TYPE="HIDDEN" NAME="subscriberid" VALUE="" /> </TABLE> </DIV> <!-- SOUPERMAIL CONFIG FILE --> <input type="hidden" name="SoupermailConf" value="tlc_app_men.txt" /> </form> <CENTER> <FONT SIZE="-2" FACE="arial, helvetica"> Instructions for removal come with every e-mail.</FONT> </CENTER> </BODY> </HTML>