{"id":3974,"date":"2025-12-22T22:20:32","date_gmt":"2025-12-22T21:20:32","guid":{"rendered":"https:\/\/bestiesplit.hr\/?page_id=3974"},"modified":"2026-01-15T02:12:43","modified_gmt":"2026-01-15T01:12:43","slug":"adoption-application","status":"publish","type":"page","link":"https:\/\/bestiesplit.hr\/de\/adoption-application\/","title":{"rendered":"Adoption Application"},"content":{"rendered":"<pre class=\"wp-block-code\"><code>&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: Please add the following &lt;META&gt; element to your page &lt;HEAD&gt;.      --&gt;\n&lt;!--  If necessary, please modify the charset parameter to specify the        --&gt;\n&lt;!--  character set of your HTML page.                                        --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;meta http-equiv=&quot;Content-type&quot; content=&quot;text\/html; charset=UTF-8&quot;&gt;\n&lt;script src=&quot;https:\/\/www.google.com\/recaptcha\/api.js&quot;&gt;&lt;\/script&gt;\n&lt;script&gt;\n function timestamp() { var response = document.getElementById(&quot;g-recaptcha-response&quot;); if (response == null || response.value.trim() == &quot;&quot;) {var elems = JSON.parse(document.getElementsByName(&quot;captcha_settings&quot;)[0].value);elems[&quot;ts&quot;] = JSON.stringify(new Date().getTime());document.getElementsByName(&quot;captcha_settings&quot;)[0].value = JSON.stringify(elems); } } setInterval(timestamp, 500); \n&lt;\/script&gt;\n\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: Please add the following &lt;FORM&gt; element to your page.             --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;form action=&quot;https:\/\/webto.salesforce.com\/servlet\/servlet.WebToLead?encoding=UTF-8&amp;orgId=00D0900000EA4YZ&quot; method=&quot;POST&quot;&gt;\n\n&lt;input type=&quot;hidden&quot; name=&#039;captcha_settings&#039; value=&#039;{&quot;keyname&quot;:&quot;NewParent&quot;,&quot;fallback&quot;:&quot;true&quot;,&quot;orgId&quot;:&quot;00D0900000EA4YZ&quot;,&quot;ts&quot;:&quot;&quot;}&#039;&gt;\n&lt;input type=&quot;hidden&quot; name=&quot;oid&quot; value=&quot;00D0900000EA4YZ&quot;&gt;\n&lt;input type=&quot;hidden&quot; name=&quot;retURL&quot; value=&quot;https:\/\/bestiesplit.hr\/thank-you-for-your-application\/&quot;&gt;\n\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: These fields are optional debugging elements. Please uncomment    --&gt;\n&lt;!--  these lines if you wish to test in debug mode.                          --&gt;\n&lt;!--  &lt;input type=&quot;hidden&quot; name=&quot;debug&quot; value=1&gt;                              --&gt;\n&lt;!--  &lt;input type=&quot;hidden&quot; name=&quot;debugEmail&quot;                                  --&gt;\n&lt;!--  value=&quot;lauriebayles1@gmail.com&quot;&gt;                                        --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;label for=&quot;first_name&quot;&gt;First Name&lt;\/label&gt;&lt;input  id=&quot;first_name&quot; maxlength=&quot;40&quot; name=&quot;first_name&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;last_name&quot;&gt;Last Name&lt;\/label&gt;&lt;input  id=&quot;last_name&quot; maxlength=&quot;80&quot; name=&quot;last_name&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;email&quot;&gt;Email&lt;\/label&gt;&lt;input  id=&quot;email&quot; maxlength=&quot;80&quot; name=&quot;email&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;company&quot;&gt;Company&lt;\/label&gt;&lt;input  id=&quot;company&quot; maxlength=&quot;40&quot; name=&quot;company&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;city&quot;&gt;City&lt;\/label&gt;&lt;input  id=&quot;city&quot; maxlength=&quot;40&quot; name=&quot;city&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;country_code&quot;&gt;Country&lt;\/label&gt;&lt;select  id=&quot;country_code&quot; name=&quot;country_code&quot;&gt;&lt;option value=&quot;&quot;&gt;--None--&lt;\/option&gt;&lt;option value=&quot;AF&quot;&gt;Afghanistan&lt;\/option&gt;\n&lt;option value=&quot;AX&quot;&gt;Aland Islands&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Albania&lt;\/option&gt;\n&lt;option value=&quot;DZ&quot;&gt;Algeria&lt;\/option&gt;\n&lt;option value=&quot;AD&quot;&gt;Andorra&lt;\/option&gt;\n&lt;option value=&quot;AO&quot;&gt;Angola&lt;\/option&gt;\n&lt;option value=&quot;AI&quot;&gt;Anguilla&lt;\/option&gt;\n&lt;option value=&quot;AQ&quot;&gt;Antarctica&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Antigua and Barbuda&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Argentina&lt;\/option&gt;\n&lt;option value=&quot;AM&quot;&gt;Armenia&lt;\/option&gt;\n&lt;option value=&quot;AW&quot;&gt;Aruba&lt;\/option&gt;\n&lt;option value=&quot;AU&quot;&gt;Australia&lt;\/option&gt;\n&lt;option value=&quot;AT&quot;&gt;Austria&lt;\/option&gt;\n&lt;option value=&quot;AZ&quot;&gt;Azerbaijan&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Bahamas&lt;\/option&gt;\n&lt;option value=&quot;BH&quot;&gt;Bahrain&lt;\/option&gt;\n&lt;option value=&quot;BD&quot;&gt;Bangladesh&lt;\/option&gt;\n&lt;option value=&quot;BB&quot;&gt;Barbados&lt;\/option&gt;\n&lt;option value=&quot;BY&quot;&gt;Belarus&lt;\/option&gt;\n&lt;option value=&quot;BE&quot;&gt;Belgium&lt;\/option&gt;\n&lt;option value=&quot;BZ&quot;&gt;Belize&lt;\/option&gt;\n&lt;option value=&quot;BJ&quot;&gt;Benin&lt;\/option&gt;\n&lt;option value=&quot;BM&quot;&gt;Bermuda&lt;\/option&gt;\n&lt;option value=&quot;BT&quot;&gt;Bhutan&lt;\/option&gt;\n&lt;option value=&quot;BO&quot;&gt;Bolivia, Plurinational State of&lt;\/option&gt;\n&lt;option value=&quot;BQ&quot;&gt;Bonaire, Sint Eustatius and Saba&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bosnia and Herzegovina&lt;\/option&gt;\n&lt;option value=&quot;BW&quot;&gt;Botswana&lt;\/option&gt;\n&lt;option value=&quot;BV&quot;&gt;Bouvet Island&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Brazil&lt;\/option&gt;\n&lt;option value=&quot;IO&quot;&gt;British Indian Ocean Territory&lt;\/option&gt;\n&lt;option value=&quot;BN&quot;&gt;Brunei Darussalam&lt;\/option&gt;\n&lt;option value=&quot;BG&quot;&gt;Bulgaria&lt;\/option&gt;\n&lt;option value=&quot;BF&quot;&gt;Burkina Faso&lt;\/option&gt;\n&lt;option value=&quot;BI&quot;&gt;Burundi&lt;\/option&gt;\n&lt;option value=&quot;KH&quot;&gt;Cambodia&lt;\/option&gt;\n&lt;option value=&quot;CM&quot;&gt;Cameroon&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;Canada&lt;\/option&gt;\n&lt;option value=&quot;CV&quot;&gt;Cape Verde&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Cayman Islands&lt;\/option&gt;\n&lt;option value=&quot;CF&quot;&gt;Central African Republic&lt;\/option&gt;\n&lt;option value=&quot;TD&quot;&gt;Chad&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Chile&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;China&lt;\/option&gt;\n&lt;option value=&quot;CX&quot;&gt;Christmas Island&lt;\/option&gt;\n&lt;option value=&quot;CC&quot;&gt;Cocos (Keeling) Islands&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Colombia&lt;\/option&gt;\n&lt;option value=&quot;KM&quot;&gt;Comoros&lt;\/option&gt;\n&lt;option value=&quot;CG&quot;&gt;Congo&lt;\/option&gt;\n&lt;option value=&quot;CD&quot;&gt;Congo, the Democratic Republic of the&lt;\/option&gt;\n&lt;option value=&quot;CK&quot;&gt;Cook Islands&lt;\/option&gt;\n&lt;option value=&quot;CR&quot;&gt;Costa Rica&lt;\/option&gt;\n&lt;option value=&quot;CI&quot;&gt;Cote d&amp;#39;Ivoire&lt;\/option&gt;\n&lt;option value=&quot;HR&quot;&gt;Croatia&lt;\/option&gt;\n&lt;option value=&quot;CU&quot;&gt;Cuba&lt;\/option&gt;\n&lt;option value=&quot;CW&quot;&gt;Cura&ccedil;ao&lt;\/option&gt;\n&lt;option value=&quot;CY&quot;&gt;Cyprus&lt;\/option&gt;\n&lt;option value=&quot;CZ&quot;&gt;Czech Republic&lt;\/option&gt;\n&lt;option value=&quot;DK&quot;&gt;Denmark&lt;\/option&gt;\n&lt;option value=&quot;DJ&quot;&gt;Djibouti&lt;\/option&gt;\n&lt;option value=&quot;DM&quot;&gt;Dominica&lt;\/option&gt;\n&lt;option value=&quot;DO&quot;&gt;Dominican Republic&lt;\/option&gt;\n&lt;option value=&quot;EC&quot;&gt;Ecuador&lt;\/option&gt;\n&lt;option value=&quot;EG&quot;&gt;Egypt&lt;\/option&gt;\n&lt;option value=&quot;SV&quot;&gt;El Salvador&lt;\/option&gt;\n&lt;option value=&quot;GQ&quot;&gt;Equatorial Guinea&lt;\/option&gt;\n&lt;option value=&quot;ER&quot;&gt;Eritrea&lt;\/option&gt;\n&lt;option value=&quot;EE&quot;&gt;Estonia&lt;\/option&gt;\n&lt;option value=&quot;ET&quot;&gt;Ethiopia&lt;\/option&gt;\n&lt;option value=&quot;FK&quot;&gt;Falkland Islands (Malvinas)&lt;\/option&gt;\n&lt;option value=&quot;FO&quot;&gt;Faroe Islands&lt;\/option&gt;\n&lt;option value=&quot;FJ&quot;&gt;Fiji&lt;\/option&gt;\n&lt;option value=&quot;FI&quot;&gt;Finland&lt;\/option&gt;\n&lt;option value=&quot;FR&quot;&gt;France&lt;\/option&gt;\n&lt;option value=&quot;GF&quot;&gt;French Guiana&lt;\/option&gt;\n&lt;option value=&quot;PF&quot;&gt;French Polynesia&lt;\/option&gt;\n&lt;option value=&quot;TF&quot;&gt;French Southern Territories&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Gabon&lt;\/option&gt;\n&lt;option value=&quot;GM&quot;&gt;Gambia&lt;\/option&gt;\n&lt;option value=&quot;GE&quot;&gt;Georgia&lt;\/option&gt;\n&lt;option value=&quot;DE&quot;&gt;Germany&lt;\/option&gt;\n&lt;option value=&quot;GH&quot;&gt;Ghana&lt;\/option&gt;\n&lt;option value=&quot;GI&quot;&gt;Gibraltar&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Greece&lt;\/option&gt;\n&lt;option value=&quot;GL&quot;&gt;Greenland&lt;\/option&gt;\n&lt;option value=&quot;GD&quot;&gt;Grenada&lt;\/option&gt;\n&lt;option value=&quot;GP&quot;&gt;Guadeloupe&lt;\/option&gt;\n&lt;option value=&quot;GT&quot;&gt;Guatemala&lt;\/option&gt;\n&lt;option value=&quot;GG&quot;&gt;Guernsey&lt;\/option&gt;\n&lt;option value=&quot;GN&quot;&gt;Guinea&lt;\/option&gt;\n&lt;option value=&quot;GW&quot;&gt;Guinea-Bissau&lt;\/option&gt;\n&lt;option value=&quot;GY&quot;&gt;Guyana&lt;\/option&gt;\n&lt;option value=&quot;HT&quot;&gt;Haiti&lt;\/option&gt;\n&lt;option value=&quot;HM&quot;&gt;Heard Island and McDonald Islands&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Holy See (Vatican City State)&lt;\/option&gt;\n&lt;option value=&quot;HN&quot;&gt;Honduras&lt;\/option&gt;\n&lt;option value=&quot;HU&quot;&gt;Hungary&lt;\/option&gt;\n&lt;option value=&quot;IS&quot;&gt;Iceland&lt;\/option&gt;\n&lt;option value=&quot;IN&quot;&gt;India&lt;\/option&gt;\n&lt;option value=&quot;ID&quot;&gt;Indonesia&lt;\/option&gt;\n&lt;option value=&quot;IR&quot;&gt;Iran, Islamic Republic of&lt;\/option&gt;\n&lt;option value=&quot;IQ&quot;&gt;Iraq&lt;\/option&gt;\n&lt;option value=&quot;IE&quot;&gt;Ireland&lt;\/option&gt;\n&lt;option value=&quot;IM&quot;&gt;Isle of Man&lt;\/option&gt;\n&lt;option value=&quot;IL&quot;&gt;Israel&lt;\/option&gt;\n&lt;option value=&quot;IT&quot;&gt;Italy&lt;\/option&gt;\n&lt;option value=&quot;JM&quot;&gt;Jamaica&lt;\/option&gt;\n&lt;option value=&quot;JP&quot;&gt;Japan&lt;\/option&gt;\n&lt;option value=&quot;JE&quot;&gt;Jersey&lt;\/option&gt;\n&lt;option value=&quot;JO&quot;&gt;Jordan&lt;\/option&gt;\n&lt;option value=&quot;KZ&quot;&gt;Kazakhstan&lt;\/option&gt;\n&lt;option value=&quot;KE&quot;&gt;Kenya&lt;\/option&gt;\n&lt;option value=&quot;KI&quot;&gt;Kiribati&lt;\/option&gt;\n&lt;option value=&quot;KP&quot;&gt;Korea, Democratic People&amp;#39;s Republic of&lt;\/option&gt;\n&lt;option value=&quot;KR&quot;&gt;Korea, Republic of&lt;\/option&gt;\n&lt;option value=&quot;KW&quot;&gt;Kuwait&lt;\/option&gt;\n&lt;option value=&quot;KG&quot;&gt;Kyrgyzstan&lt;\/option&gt;\n&lt;option value=&quot;LA&quot;&gt;Lao People&amp;#39;s Democratic Republic&lt;\/option&gt;\n&lt;option value=&quot;LV&quot;&gt;Latvia&lt;\/option&gt;\n&lt;option value=&quot;LB&quot;&gt;Lebanon&lt;\/option&gt;\n&lt;option value=&quot;LS&quot;&gt;Lesotho&lt;\/option&gt;\n&lt;option value=&quot;LR&quot;&gt;Liberia&lt;\/option&gt;\n&lt;option value=&quot;LY&quot;&gt;Libya&lt;\/option&gt;\n&lt;option value=&quot;LI&quot;&gt;Liechtenstein&lt;\/option&gt;\n&lt;option value=&quot;LT&quot;&gt;Lithuania&lt;\/option&gt;\n&lt;option value=&quot;LU&quot;&gt;Luxembourg&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Macao&lt;\/option&gt;\n&lt;option value=&quot;MK&quot;&gt;Macedonia, the former Yugoslav Republic of&lt;\/option&gt;\n&lt;option value=&quot;MG&quot;&gt;Madagascar&lt;\/option&gt;\n&lt;option value=&quot;MW&quot;&gt;Malawi&lt;\/option&gt;\n&lt;option value=&quot;MY&quot;&gt;Malaysia&lt;\/option&gt;\n&lt;option value=&quot;MV&quot;&gt;Maldives&lt;\/option&gt;\n&lt;option value=&quot;ML&quot;&gt;Mali&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Malta&lt;\/option&gt;\n&lt;option value=&quot;MQ&quot;&gt;Martinique&lt;\/option&gt;\n&lt;option value=&quot;MR&quot;&gt;Mauritania&lt;\/option&gt;\n&lt;option value=&quot;MU&quot;&gt;Mauritius&lt;\/option&gt;\n&lt;option value=&quot;YT&quot;&gt;Mayotte&lt;\/option&gt;\n&lt;option value=&quot;MX&quot;&gt;Mexico&lt;\/option&gt;\n&lt;option value=&quot;MD&quot;&gt;Moldova, Republic of&lt;\/option&gt;\n&lt;option value=&quot;MC&quot;&gt;Monaco&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Mongolia&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Montenegro&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Montserrat&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Morocco&lt;\/option&gt;\n&lt;option value=&quot;MZ&quot;&gt;Mozambique&lt;\/option&gt;\n&lt;option value=&quot;MM&quot;&gt;Myanmar&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Namibia&lt;\/option&gt;\n&lt;option value=&quot;NR&quot;&gt;Nauru&lt;\/option&gt;\n&lt;option value=&quot;NP&quot;&gt;Nepal&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Netherlands&lt;\/option&gt;\n&lt;option value=&quot;NC&quot;&gt;New Caledonia&lt;\/option&gt;\n&lt;option value=&quot;NZ&quot;&gt;New Zealand&lt;\/option&gt;\n&lt;option value=&quot;NI&quot;&gt;Nicaragua&lt;\/option&gt;\n&lt;option value=&quot;NE&quot;&gt;Niger&lt;\/option&gt;\n&lt;option value=&quot;NG&quot;&gt;Nigeria&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Niue&lt;\/option&gt;\n&lt;option value=&quot;NF&quot;&gt;Norfolk Island&lt;\/option&gt;\n&lt;option value=&quot;NO&quot;&gt;Norway&lt;\/option&gt;\n&lt;option value=&quot;OM&quot;&gt;Oman&lt;\/option&gt;\n&lt;option value=&quot;PK&quot;&gt;Pakistan&lt;\/option&gt;\n&lt;option value=&quot;PS&quot;&gt;Palestine&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Panama&lt;\/option&gt;\n&lt;option value=&quot;PG&quot;&gt;Papua New Guinea&lt;\/option&gt;\n&lt;option value=&quot;PY&quot;&gt;Paraguay&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Peru&lt;\/option&gt;\n&lt;option value=&quot;PH&quot;&gt;Philippines&lt;\/option&gt;\n&lt;option value=&quot;PN&quot;&gt;Pitcairn&lt;\/option&gt;\n&lt;option value=&quot;PL&quot;&gt;Poland&lt;\/option&gt;\n&lt;option value=&quot;PT&quot;&gt;Portugal&lt;\/option&gt;\n&lt;option value=&quot;QA&quot;&gt;Qatar&lt;\/option&gt;\n&lt;option value=&quot;RE&quot;&gt;Reunion&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Romania&lt;\/option&gt;\n&lt;option value=&quot;RU&quot;&gt;Russian Federation&lt;\/option&gt;\n&lt;option value=&quot;RW&quot;&gt;Rwanda&lt;\/option&gt;\n&lt;option value=&quot;BL&quot;&gt;Saint Barth&eacute;lemy&lt;\/option&gt;\n&lt;option value=&quot;SH&quot;&gt;Saint Helena, Ascension and Tristan da Cunha&lt;\/option&gt;\n&lt;option value=&quot;KN&quot;&gt;Saint Kitts and Nevis&lt;\/option&gt;\n&lt;option value=&quot;LC&quot;&gt;Saint Lucia&lt;\/option&gt;\n&lt;option value=&quot;MF&quot;&gt;Saint Martin (French part)&lt;\/option&gt;\n&lt;option value=&quot;PM&quot;&gt;Saint Pierre and Miquelon&lt;\/option&gt;\n&lt;option value=&quot;VC&quot;&gt;Saint Vincent and the Grenadines&lt;\/option&gt;\n&lt;option value=&quot;WS&quot;&gt;Samoa&lt;\/option&gt;\n&lt;option value=&quot;SM&quot;&gt;San Marino&lt;\/option&gt;\n&lt;option value=&quot;ST&quot;&gt;Sao Tome and Principe&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;Saudi Arabia&lt;\/option&gt;\n&lt;option value=&quot;SN&quot;&gt;Senegal&lt;\/option&gt;\n&lt;option value=&quot;RS&quot;&gt;Serbia&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;Seychelles&lt;\/option&gt;\n&lt;option value=&quot;SL&quot;&gt;Sierra Leone&lt;\/option&gt;\n&lt;option value=&quot;SG&quot;&gt;Singapore&lt;\/option&gt;\n&lt;option value=&quot;SX&quot;&gt;Sint Maarten (Dutch part)&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Slovakia&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Slovenia&lt;\/option&gt;\n&lt;option value=&quot;SB&quot;&gt;Solomon Islands&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Somalia&lt;\/option&gt;\n&lt;option value=&quot;ZA&quot;&gt;South Africa&lt;\/option&gt;\n&lt;option value=&quot;GS&quot;&gt;South Georgia and the South Sandwich Islands&lt;\/option&gt;\n&lt;option value=&quot;SS&quot;&gt;South Sudan&lt;\/option&gt;\n&lt;option value=&quot;ES&quot;&gt;Spain&lt;\/option&gt;\n&lt;option value=&quot;LK&quot;&gt;Sri Lanka&lt;\/option&gt;\n&lt;option value=&quot;SD&quot;&gt;Sudan&lt;\/option&gt;\n&lt;option value=&quot;SR&quot;&gt;Suriname&lt;\/option&gt;\n&lt;option value=&quot;SJ&quot;&gt;Svalbard and Jan Mayen&lt;\/option&gt;\n&lt;option value=&quot;SZ&quot;&gt;Swaziland&lt;\/option&gt;\n&lt;option value=&quot;SE&quot;&gt;Sweden&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Switzerland&lt;\/option&gt;\n&lt;option value=&quot;SY&quot;&gt;Syrian Arab Republic&lt;\/option&gt;\n&lt;option value=&quot;TW&quot;&gt;Taiwan&lt;\/option&gt;\n&lt;option value=&quot;TJ&quot;&gt;Tajikistan&lt;\/option&gt;\n&lt;option value=&quot;TZ&quot;&gt;Tanzania, United Republic of&lt;\/option&gt;\n&lt;option value=&quot;TH&quot;&gt;Thailand&lt;\/option&gt;\n&lt;option value=&quot;TL&quot;&gt;Timor-Leste&lt;\/option&gt;\n&lt;option value=&quot;TG&quot;&gt;Togo&lt;\/option&gt;\n&lt;option value=&quot;TK&quot;&gt;Tokelau&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Tonga&lt;\/option&gt;\n&lt;option value=&quot;TT&quot;&gt;Trinidad and Tobago&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tunisia&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Turkey&lt;\/option&gt;\n&lt;option value=&quot;TM&quot;&gt;Turkmenistan&lt;\/option&gt;\n&lt;option value=&quot;TC&quot;&gt;Turks and Caicos Islands&lt;\/option&gt;\n&lt;option value=&quot;TV&quot;&gt;Tuvalu&lt;\/option&gt;\n&lt;option value=&quot;UG&quot;&gt;Uganda&lt;\/option&gt;\n&lt;option value=&quot;UA&quot;&gt;Ukraine&lt;\/option&gt;\n&lt;option value=&quot;AE&quot;&gt;United Arab Emirates&lt;\/option&gt;\n&lt;option value=&quot;GB&quot;&gt;United Kingdom&lt;\/option&gt;\n&lt;option value=&quot;US&quot;&gt;United States&lt;\/option&gt;\n&lt;option value=&quot;UY&quot;&gt;Uruguay&lt;\/option&gt;\n&lt;option value=&quot;UZ&quot;&gt;Uzbekistan&lt;\/option&gt;\n&lt;option value=&quot;VU&quot;&gt;Vanuatu&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Venezuela, Bolivarian Republic of&lt;\/option&gt;\n&lt;option value=&quot;VN&quot;&gt;Vietnam&lt;\/option&gt;\n&lt;option value=&quot;VG&quot;&gt;Virgin Islands, British&lt;\/option&gt;\n&lt;option value=&quot;WF&quot;&gt;Wallis and Futuna&lt;\/option&gt;\n&lt;option value=&quot;EH&quot;&gt;Western Sahara&lt;\/option&gt;\n&lt;option value=&quot;YE&quot;&gt;Yemen&lt;\/option&gt;\n&lt;option value=&quot;ZM&quot;&gt;Zambia&lt;\/option&gt;\n&lt;option value=&quot;ZW&quot;&gt;Zimbabwe&lt;\/option&gt;\n&lt;\/select&gt;&lt;br&gt;\n\n&lt;label for=&quot;state_code&quot;&gt;State\/Province&lt;\/label&gt;&lt;select  id=&quot;state_code&quot; name=&quot;state_code&quot;&gt;&lt;option value=&quot;&quot;&gt;--None--&lt;\/option&gt;&lt;option value=&quot;AC&quot;&gt;Acre&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Agrigento&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Aguascalientes&lt;\/option&gt;\n&lt;option value=&quot;05&quot;&gt;Aichi&lt;\/option&gt;\n&lt;option value=&quot;02&quot;&gt;Akita&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alabama&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alagoas&lt;\/option&gt;\n&lt;option value=&quot;AK&quot;&gt;Alaska&lt;\/option&gt;\n&lt;option value=&quot;AB&quot;&gt;Alberta&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alessandria&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Amap&aacute;&lt;\/option&gt;\n&lt;option value=&quot;AM&quot;&gt;Amazonas&lt;\/option&gt;\n&lt;option value=&quot;AN&quot;&gt;Ancona&lt;\/option&gt;\n&lt;option value=&quot;AN&quot;&gt;Andaman and Nicobar Islands&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Andhra Pradesh&lt;\/option&gt;\n&lt;option value=&quot;34&quot;&gt;Anhui&lt;\/option&gt;\n&lt;option value=&quot;23&quot;&gt;Aomori&lt;\/option&gt;\n&lt;option value=&quot;AO&quot;&gt;Aosta&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arezzo&lt;\/option&gt;\n&lt;option value=&quot;AZ&quot;&gt;Arizona&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arkansas&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arunachal Pradesh&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Ascoli Piceno&lt;\/option&gt;\n&lt;option value=&quot;AS&quot;&gt;Assam&lt;\/option&gt;\n&lt;option value=&quot;AT&quot;&gt;Asti&lt;\/option&gt;\n&lt;option value=&quot;ACT&quot;&gt;Australian Capital Territory&lt;\/option&gt;\n&lt;option value=&quot;AV&quot;&gt;Avellino&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bahia&lt;\/option&gt;\n&lt;option value=&quot;BC&quot;&gt;Baja California&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Baja California Sur&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bari&lt;\/option&gt;\n&lt;option value=&quot;BT&quot;&gt;Barletta-Andria-Trani&lt;\/option&gt;\n&lt;option value=&quot;11&quot;&gt;Beijing&lt;\/option&gt;\n&lt;option value=&quot;BL&quot;&gt;Belluno&lt;\/option&gt;\n&lt;option value=&quot;BN&quot;&gt;Benevento&lt;\/option&gt;\n&lt;option value=&quot;BG&quot;&gt;Bergamo&lt;\/option&gt;\n&lt;option value=&quot;BI&quot;&gt;Biella&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Bihar&lt;\/option&gt;\n&lt;option value=&quot;BO&quot;&gt;Bologna&lt;\/option&gt;\n&lt;option value=&quot;BZ&quot;&gt;Bolzano&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Brescia&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Brindisi&lt;\/option&gt;\n&lt;option value=&quot;BC&quot;&gt;British Columbia&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;Cagliari&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;California&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Caltanissetta&lt;\/option&gt;\n&lt;option value=&quot;CM&quot;&gt;Campeche&lt;\/option&gt;\n&lt;option value=&quot;CB&quot;&gt;Campobasso&lt;\/option&gt;\n&lt;option value=&quot;CI&quot;&gt;Carbonia-Iglesias&lt;\/option&gt;\n&lt;option value=&quot;CW&quot;&gt;Carlow&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Caserta&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Catania&lt;\/option&gt;\n&lt;option value=&quot;CZ&quot;&gt;Catanzaro&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;Cavan&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Cear&aacute;&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chandigarh&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Chhattisgarh&lt;\/option&gt;\n&lt;option value=&quot;CS&quot;&gt;Chiapas&lt;\/option&gt;\n&lt;option value=&quot;12&quot;&gt;Chiba&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chieti&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chihuahua&lt;\/option&gt;\n&lt;option value=&quot;50&quot;&gt;Chongqing&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Clare&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Coahuila&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Colima&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Colorado&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Como&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Connecticut&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Cork&lt;\/option&gt;\n&lt;option value=&quot;CS&quot;&gt;Cosenza&lt;\/option&gt;\n&lt;option value=&quot;CR&quot;&gt;Cremona&lt;\/option&gt;\n&lt;option value=&quot;KR&quot;&gt;Crotone&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;Cuneo&lt;\/option&gt;\n&lt;option value=&quot;DN&quot;&gt;Dadra and Nagar Haveli&lt;\/option&gt;\n&lt;option value=&quot;DD&quot;&gt;Daman and Diu&lt;\/option&gt;\n&lt;option value=&quot;DE&quot;&gt;Delaware&lt;\/option&gt;\n&lt;option value=&quot;DL&quot;&gt;Delhi&lt;\/option&gt;\n&lt;option value=&quot;DC&quot;&gt;District of Columbia&lt;\/option&gt;\n&lt;option value=&quot;DF&quot;&gt;Distrito Federal&lt;\/option&gt;\n&lt;option value=&quot;DL&quot;&gt;Donegal&lt;\/option&gt;\n&lt;option value=&quot;D&quot;&gt;Dublin&lt;\/option&gt;\n&lt;option value=&quot;DG&quot;&gt;Durango&lt;\/option&gt;\n&lt;option value=&quot;38&quot;&gt;Ehime&lt;\/option&gt;\n&lt;option value=&quot;EN&quot;&gt;Enna&lt;\/option&gt;\n&lt;option value=&quot;ES&quot;&gt;Esp&iacute;rito Santo&lt;\/option&gt;\n&lt;option value=&quot;DF&quot;&gt;Federal District&lt;\/option&gt;\n&lt;option value=&quot;FM&quot;&gt;Fermo&lt;\/option&gt;\n&lt;option value=&quot;FE&quot;&gt;Ferrara&lt;\/option&gt;\n&lt;option value=&quot;FI&quot;&gt;Florence&lt;\/option&gt;\n&lt;option value=&quot;FL&quot;&gt;Florida&lt;\/option&gt;\n&lt;option value=&quot;FG&quot;&gt;Foggia&lt;\/option&gt;\n&lt;option value=&quot;FC&quot;&gt;Forl&igrave;-Cesena&lt;\/option&gt;\n&lt;option value=&quot;FR&quot;&gt;Frosinone&lt;\/option&gt;\n&lt;option value=&quot;35&quot;&gt;Fujian&lt;\/option&gt;\n&lt;option value=&quot;18&quot;&gt;Fukui&lt;\/option&gt;\n&lt;option value=&quot;40&quot;&gt;Fukuoka&lt;\/option&gt;\n&lt;option value=&quot;07&quot;&gt;Fukushima&lt;\/option&gt;\n&lt;option value=&quot;G&quot;&gt;Galway&lt;\/option&gt;\n&lt;option value=&quot;62&quot;&gt;Gansu&lt;\/option&gt;\n&lt;option value=&quot;GE&quot;&gt;Genoa&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Georgia&lt;\/option&gt;\n&lt;option value=&quot;21&quot;&gt;Gifu&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Goa&lt;\/option&gt;\n&lt;option value=&quot;GO&quot;&gt;Goi&aacute;s&lt;\/option&gt;\n&lt;option value=&quot;GO&quot;&gt;Gorizia&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Grosseto&lt;\/option&gt;\n&lt;option value=&quot;GT&quot;&gt;Guanajuato&lt;\/option&gt;\n&lt;option value=&quot;44&quot;&gt;Guangdong&lt;\/option&gt;\n&lt;option value=&quot;45&quot;&gt;Guangxi&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Guerrero&lt;\/option&gt;\n&lt;option value=&quot;52&quot;&gt;Guizhou&lt;\/option&gt;\n&lt;option value=&quot;GJ&quot;&gt;Gujarat&lt;\/option&gt;\n&lt;option value=&quot;10&quot;&gt;Gunma&lt;\/option&gt;\n&lt;option value=&quot;46&quot;&gt;Hainan&lt;\/option&gt;\n&lt;option value=&quot;HR&quot;&gt;Haryana&lt;\/option&gt;\n&lt;option value=&quot;HI&quot;&gt;Hawaii&lt;\/option&gt;\n&lt;option value=&quot;13&quot;&gt;Hebei&lt;\/option&gt;\n&lt;option value=&quot;23&quot;&gt;Heilongjiang&lt;\/option&gt;\n&lt;option value=&quot;41&quot;&gt;Henan&lt;\/option&gt;\n&lt;option value=&quot;HG&quot;&gt;Hidalgo&lt;\/option&gt;\n&lt;option value=&quot;HP&quot;&gt;Himachal Pradesh&lt;\/option&gt;\n&lt;option value=&quot;34&quot;&gt;Hiroshima&lt;\/option&gt;\n&lt;option value=&quot;01&quot;&gt;Hokkaido&lt;\/option&gt;\n&lt;option value=&quot;91&quot;&gt;Hong Kong&lt;\/option&gt;\n&lt;option value=&quot;42&quot;&gt;Hubei&lt;\/option&gt;\n&lt;option value=&quot;43&quot;&gt;Hunan&lt;\/option&gt;\n&lt;option value=&quot;28&quot;&gt;Hyogo&lt;\/option&gt;\n&lt;option value=&quot;08&quot;&gt;Ibaraki&lt;\/option&gt;\n&lt;option value=&quot;ID&quot;&gt;Idaho&lt;\/option&gt;\n&lt;option value=&quot;IL&quot;&gt;Illinois&lt;\/option&gt;\n&lt;option value=&quot;IM&quot;&gt;Imperia&lt;\/option&gt;\n&lt;option value=&quot;IN&quot;&gt;Indiana&lt;\/option&gt;\n&lt;option value=&quot;IA&quot;&gt;Iowa&lt;\/option&gt;\n&lt;option value=&quot;IS&quot;&gt;Isernia&lt;\/option&gt;\n&lt;option value=&quot;17&quot;&gt;Ishikawa&lt;\/option&gt;\n&lt;option value=&quot;03&quot;&gt;Iwate&lt;\/option&gt;\n&lt;option value=&quot;JA&quot;&gt;Jalisco&lt;\/option&gt;\n&lt;option value=&quot;JK&quot;&gt;Jammu and Kashmir&lt;\/option&gt;\n&lt;option value=&quot;JH&quot;&gt;Jharkhand&lt;\/option&gt;\n&lt;option value=&quot;32&quot;&gt;Jiangsu&lt;\/option&gt;\n&lt;option value=&quot;36&quot;&gt;Jiangxi&lt;\/option&gt;\n&lt;option value=&quot;22&quot;&gt;Jilin&lt;\/option&gt;\n&lt;option value=&quot;37&quot;&gt;Kagawa&lt;\/option&gt;\n&lt;option value=&quot;46&quot;&gt;Kagoshima&lt;\/option&gt;\n&lt;option value=&quot;14&quot;&gt;Kanagawa&lt;\/option&gt;\n&lt;option value=&quot;KS&quot;&gt;Kansas&lt;\/option&gt;\n&lt;option value=&quot;KA&quot;&gt;Karnataka&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Kentucky&lt;\/option&gt;\n&lt;option value=&quot;KL&quot;&gt;Kerala&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Kerry&lt;\/option&gt;\n&lt;option value=&quot;KE&quot;&gt;Kildare&lt;\/option&gt;\n&lt;option value=&quot;KK&quot;&gt;Kilkenny&lt;\/option&gt;\n&lt;option value=&quot;39&quot;&gt;Kochi&lt;\/option&gt;\n&lt;option value=&quot;43&quot;&gt;Kumamoto&lt;\/option&gt;\n&lt;option value=&quot;26&quot;&gt;Kyoto&lt;\/option&gt;\n&lt;option value=&quot;AQ&quot;&gt;L&amp;#39;Aquila&lt;\/option&gt;\n&lt;option value=&quot;LD&quot;&gt;Lakshadweep&lt;\/option&gt;\n&lt;option value=&quot;LS&quot;&gt;Laois&lt;\/option&gt;\n&lt;option value=&quot;SP&quot;&gt;La Spezia&lt;\/option&gt;\n&lt;option value=&quot;LT&quot;&gt;Latina&lt;\/option&gt;\n&lt;option value=&quot;LE&quot;&gt;Lecce&lt;\/option&gt;\n&lt;option value=&quot;LC&quot;&gt;Lecco&lt;\/option&gt;\n&lt;option value=&quot;LM&quot;&gt;Leitrim&lt;\/option&gt;\n&lt;option value=&quot;21&quot;&gt;Liaoning&lt;\/option&gt;\n&lt;option value=&quot;LK&quot;&gt;Limerick&lt;\/option&gt;\n&lt;option value=&quot;LI&quot;&gt;Livorno&lt;\/option&gt;\n&lt;option value=&quot;LO&quot;&gt;Lodi&lt;\/option&gt;\n&lt;option value=&quot;LD&quot;&gt;Longford&lt;\/option&gt;\n&lt;option value=&quot;LA&quot;&gt;Louisiana&lt;\/option&gt;\n&lt;option value=&quot;LH&quot;&gt;Louth&lt;\/option&gt;\n&lt;option value=&quot;LU&quot;&gt;Lucca&lt;\/option&gt;\n&lt;option value=&quot;92&quot;&gt;Macao&lt;\/option&gt;\n&lt;option value=&quot;MC&quot;&gt;Macerata&lt;\/option&gt;\n&lt;option value=&quot;MP&quot;&gt;Madhya Pradesh&lt;\/option&gt;\n&lt;option value=&quot;MH&quot;&gt;Maharashtra&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Maine&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Manipur&lt;\/option&gt;\n&lt;option value=&quot;MB&quot;&gt;Manitoba&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Mantua&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Maranh&atilde;o&lt;\/option&gt;\n&lt;option value=&quot;MD&quot;&gt;Maryland&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Massa and Carrara&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Massachusetts&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Matera&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Mato Grosso&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Mato Grosso do Sul&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Mayo&lt;\/option&gt;\n&lt;option value=&quot;MH&quot;&gt;Meath&lt;\/option&gt;\n&lt;option value=&quot;VS&quot;&gt;Medio Campidano&lt;\/option&gt;\n&lt;option value=&quot;ML&quot;&gt;Meghalaya&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Messina&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Mexico State&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Michigan&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Michoac&aacute;n&lt;\/option&gt;\n&lt;option value=&quot;24&quot;&gt;Mie&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Milan&lt;\/option&gt;\n&lt;option value=&quot;MG&quot;&gt;Minas Gerais&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Minnesota&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Mississippi&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Missouri&lt;\/option&gt;\n&lt;option value=&quot;04&quot;&gt;Miyagi&lt;\/option&gt;\n&lt;option value=&quot;45&quot;&gt;Miyazaki&lt;\/option&gt;\n&lt;option value=&quot;MZ&quot;&gt;Mizoram&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Modena&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Monaghan&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Montana&lt;\/option&gt;\n&lt;option value=&quot;MB&quot;&gt;Monza and Brianza&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Morelos&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Nagaland&lt;\/option&gt;\n&lt;option value=&quot;20&quot;&gt;Nagano&lt;\/option&gt;\n&lt;option value=&quot;42&quot;&gt;Nagasaki&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Naples&lt;\/option&gt;\n&lt;option value=&quot;29&quot;&gt;Nara&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Nayarit&lt;\/option&gt;\n&lt;option value=&quot;NE&quot;&gt;Nebraska&lt;\/option&gt;\n&lt;option value=&quot;15&quot;&gt;Nei Mongol&lt;\/option&gt;\n&lt;option value=&quot;NV&quot;&gt;Nevada&lt;\/option&gt;\n&lt;option value=&quot;NB&quot;&gt;New Brunswick&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Newfoundland and Labrador&lt;\/option&gt;\n&lt;option value=&quot;NH&quot;&gt;New Hampshire&lt;\/option&gt;\n&lt;option value=&quot;NJ&quot;&gt;New Jersey&lt;\/option&gt;\n&lt;option value=&quot;NM&quot;&gt;New Mexico&lt;\/option&gt;\n&lt;option value=&quot;NSW&quot;&gt;New South Wales&lt;\/option&gt;\n&lt;option value=&quot;NY&quot;&gt;New York&lt;\/option&gt;\n&lt;option value=&quot;15&quot;&gt;Niigata&lt;\/option&gt;\n&lt;option value=&quot;64&quot;&gt;Ningxia&lt;\/option&gt;\n&lt;option value=&quot;NC&quot;&gt;North Carolina&lt;\/option&gt;\n&lt;option value=&quot;ND&quot;&gt;North Dakota&lt;\/option&gt;\n&lt;option value=&quot;NT&quot;&gt;Northern Territory&lt;\/option&gt;\n&lt;option value=&quot;NT&quot;&gt;Northwest Territories&lt;\/option&gt;\n&lt;option value=&quot;NO&quot;&gt;Novara&lt;\/option&gt;\n&lt;option value=&quot;NS&quot;&gt;Nova Scotia&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Nuevo Le&oacute;n&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Nunavut&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Nuoro&lt;\/option&gt;\n&lt;option value=&quot;OA&quot;&gt;Oaxaca&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Odisha&lt;\/option&gt;\n&lt;option value=&quot;OY&quot;&gt;Offaly&lt;\/option&gt;\n&lt;option value=&quot;OG&quot;&gt;Ogliastra&lt;\/option&gt;\n&lt;option value=&quot;OH&quot;&gt;Ohio&lt;\/option&gt;\n&lt;option value=&quot;44&quot;&gt;Oita&lt;\/option&gt;\n&lt;option value=&quot;33&quot;&gt;Okayama&lt;\/option&gt;\n&lt;option value=&quot;47&quot;&gt;Okinawa&lt;\/option&gt;\n&lt;option value=&quot;OK&quot;&gt;Oklahoma&lt;\/option&gt;\n&lt;option value=&quot;OT&quot;&gt;Olbia-Tempio&lt;\/option&gt;\n&lt;option value=&quot;ON&quot;&gt;Ontario&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Oregon&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Oristano&lt;\/option&gt;\n&lt;option value=&quot;27&quot;&gt;Osaka&lt;\/option&gt;\n&lt;option value=&quot;PD&quot;&gt;Padua&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Palermo&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Par&aacute;&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Para&iacute;ba&lt;\/option&gt;\n&lt;option value=&quot;PR&quot;&gt;Paran&aacute;&lt;\/option&gt;\n&lt;option value=&quot;PR&quot;&gt;Parma&lt;\/option&gt;\n&lt;option value=&quot;PV&quot;&gt;Pavia&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Pennsylvania&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Pernambuco&lt;\/option&gt;\n&lt;option value=&quot;PG&quot;&gt;Perugia&lt;\/option&gt;\n&lt;option value=&quot;PU&quot;&gt;Pesaro and Urbino&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Pescara&lt;\/option&gt;\n&lt;option value=&quot;PC&quot;&gt;Piacenza&lt;\/option&gt;\n&lt;option value=&quot;PI&quot;&gt;Piau&iacute;&lt;\/option&gt;\n&lt;option value=&quot;PI&quot;&gt;Pisa&lt;\/option&gt;\n&lt;option value=&quot;PT&quot;&gt;Pistoia&lt;\/option&gt;\n&lt;option value=&quot;PN&quot;&gt;Pordenone&lt;\/option&gt;\n&lt;option value=&quot;PZ&quot;&gt;Potenza&lt;\/option&gt;\n&lt;option value=&quot;PO&quot;&gt;Prato&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Prince Edward Island&lt;\/option&gt;\n&lt;option value=&quot;PY&quot;&gt;Puducherry&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Puebla&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Punjab&lt;\/option&gt;\n&lt;option value=&quot;63&quot;&gt;Qinghai&lt;\/option&gt;\n&lt;option value=&quot;QC&quot;&gt;Quebec&lt;\/option&gt;\n&lt;option value=&quot;QLD&quot;&gt;Queensland&lt;\/option&gt;\n&lt;option value=&quot;QE&quot;&gt;Quer&eacute;taro&lt;\/option&gt;\n&lt;option value=&quot;QR&quot;&gt;Quintana Roo&lt;\/option&gt;\n&lt;option value=&quot;RG&quot;&gt;Ragusa&lt;\/option&gt;\n&lt;option value=&quot;RJ&quot;&gt;Rajasthan&lt;\/option&gt;\n&lt;option value=&quot;RA&quot;&gt;Ravenna&lt;\/option&gt;\n&lt;option value=&quot;RC&quot;&gt;Reggio Calabria&lt;\/option&gt;\n&lt;option value=&quot;RE&quot;&gt;Reggio Emilia&lt;\/option&gt;\n&lt;option value=&quot;RI&quot;&gt;Rhode Island&lt;\/option&gt;\n&lt;option value=&quot;RI&quot;&gt;Rieti&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Rimini&lt;\/option&gt;\n&lt;option value=&quot;RJ&quot;&gt;Rio de Janeiro&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Rio Grande do Norte&lt;\/option&gt;\n&lt;option value=&quot;RS&quot;&gt;Rio Grande do Sul&lt;\/option&gt;\n&lt;option value=&quot;RM&quot;&gt;Rome&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Rond&ocirc;nia&lt;\/option&gt;\n&lt;option value=&quot;RR&quot;&gt;Roraima&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Roscommon&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Rovigo&lt;\/option&gt;\n&lt;option value=&quot;41&quot;&gt;Saga&lt;\/option&gt;\n&lt;option value=&quot;11&quot;&gt;Saitama&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;Salerno&lt;\/option&gt;\n&lt;option value=&quot;SL&quot;&gt;San Luis Potos&iacute;&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;Santa Catarina&lt;\/option&gt;\n&lt;option value=&quot;SP&quot;&gt;S&atilde;o Paulo&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Saskatchewan&lt;\/option&gt;\n&lt;option value=&quot;SS&quot;&gt;Sassari&lt;\/option&gt;\n&lt;option value=&quot;SV&quot;&gt;Savona&lt;\/option&gt;\n&lt;option value=&quot;SE&quot;&gt;Sergipe&lt;\/option&gt;\n&lt;option value=&quot;61&quot;&gt;Shaanxi&lt;\/option&gt;\n&lt;option value=&quot;37&quot;&gt;Shandong&lt;\/option&gt;\n&lt;option value=&quot;31&quot;&gt;Shanghai&lt;\/option&gt;\n&lt;option value=&quot;14&quot;&gt;Shanxi&lt;\/option&gt;\n&lt;option value=&quot;25&quot;&gt;Shiga&lt;\/option&gt;\n&lt;option value=&quot;32&quot;&gt;Shimane&lt;\/option&gt;\n&lt;option value=&quot;22&quot;&gt;Shizuoka&lt;\/option&gt;\n&lt;option value=&quot;51&quot;&gt;Sichuan&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Siena&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Sikkim&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Sinaloa&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sligo&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sondrio&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sonora&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;South Australia&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;South Carolina&lt;\/option&gt;\n&lt;option value=&quot;SD&quot;&gt;South Dakota&lt;\/option&gt;\n&lt;option value=&quot;SR&quot;&gt;Syracuse&lt;\/option&gt;\n&lt;option value=&quot;TB&quot;&gt;Tabasco&lt;\/option&gt;\n&lt;option value=&quot;71&quot;&gt;Taiwan&lt;\/option&gt;\n&lt;option value=&quot;TM&quot;&gt;Tamaulipas&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tamil Nadu&lt;\/option&gt;\n&lt;option value=&quot;TA&quot;&gt;Taranto&lt;\/option&gt;\n&lt;option value=&quot;TAS&quot;&gt;Tasmania&lt;\/option&gt;\n&lt;option value=&quot;TG&quot;&gt;Telangana&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tennessee&lt;\/option&gt;\n&lt;option value=&quot;TE&quot;&gt;Teramo&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Terni&lt;\/option&gt;\n&lt;option value=&quot;TX&quot;&gt;Texas&lt;\/option&gt;\n&lt;option value=&quot;12&quot;&gt;Tianjin&lt;\/option&gt;\n&lt;option value=&quot;TA&quot;&gt;Tipperary&lt;\/option&gt;\n&lt;option value=&quot;TL&quot;&gt;Tlaxcala&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Tocantins&lt;\/option&gt;\n&lt;option value=&quot;09&quot;&gt;Tochigi&lt;\/option&gt;\n&lt;option value=&quot;36&quot;&gt;Tokushima&lt;\/option&gt;\n&lt;option value=&quot;13&quot;&gt;Tokyo&lt;\/option&gt;\n&lt;option value=&quot;31&quot;&gt;Tottori&lt;\/option&gt;\n&lt;option value=&quot;16&quot;&gt;Toyama&lt;\/option&gt;\n&lt;option value=&quot;TP&quot;&gt;Trapani&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Trento&lt;\/option&gt;\n&lt;option value=&quot;TV&quot;&gt;Treviso&lt;\/option&gt;\n&lt;option value=&quot;TS&quot;&gt;Trieste&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Tripura&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Turin&lt;\/option&gt;\n&lt;option value=&quot;UD&quot;&gt;Udine&lt;\/option&gt;\n&lt;option value=&quot;UT&quot;&gt;Utah&lt;\/option&gt;\n&lt;option value=&quot;UT&quot;&gt;Uttarakhand&lt;\/option&gt;\n&lt;option value=&quot;UP&quot;&gt;Uttar Pradesh&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Varese&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Venice&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Veracruz&lt;\/option&gt;\n&lt;option value=&quot;VB&quot;&gt;Verbano-Cusio-Ossola&lt;\/option&gt;\n&lt;option value=&quot;VC&quot;&gt;Vercelli&lt;\/option&gt;\n&lt;option value=&quot;VT&quot;&gt;Vermont&lt;\/option&gt;\n&lt;option value=&quot;VR&quot;&gt;Verona&lt;\/option&gt;\n&lt;option value=&quot;VV&quot;&gt;Vibo Valentia&lt;\/option&gt;\n&lt;option value=&quot;VI&quot;&gt;Vicenza&lt;\/option&gt;\n&lt;option value=&quot;VIC&quot;&gt;Victoria&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Virginia&lt;\/option&gt;\n&lt;option value=&quot;VT&quot;&gt;Viterbo&lt;\/option&gt;\n&lt;option value=&quot;30&quot;&gt;Wakayama&lt;\/option&gt;\n&lt;option value=&quot;WA&quot;&gt;Washington&lt;\/option&gt;\n&lt;option value=&quot;WD&quot;&gt;Waterford&lt;\/option&gt;\n&lt;option value=&quot;WB&quot;&gt;West Bengal&lt;\/option&gt;\n&lt;option value=&quot;WA&quot;&gt;Western Australia&lt;\/option&gt;\n&lt;option value=&quot;WH&quot;&gt;Westmeath&lt;\/option&gt;\n&lt;option value=&quot;WV&quot;&gt;West Virginia&lt;\/option&gt;\n&lt;option value=&quot;WX&quot;&gt;Wexford&lt;\/option&gt;\n&lt;option value=&quot;WW&quot;&gt;Wicklow&lt;\/option&gt;\n&lt;option value=&quot;WI&quot;&gt;Wisconsin&lt;\/option&gt;\n&lt;option value=&quot;WY&quot;&gt;Wyoming&lt;\/option&gt;\n&lt;option value=&quot;65&quot;&gt;Xinjiang&lt;\/option&gt;\n&lt;option value=&quot;54&quot;&gt;Xizang&lt;\/option&gt;\n&lt;option value=&quot;06&quot;&gt;Yamagata&lt;\/option&gt;\n&lt;option value=&quot;35&quot;&gt;Yamaguchi&lt;\/option&gt;\n&lt;option value=&quot;19&quot;&gt;Yamanashi&lt;\/option&gt;\n&lt;option value=&quot;YU&quot;&gt;Yucat&aacute;n&lt;\/option&gt;\n&lt;option value=&quot;YT&quot;&gt;Yukon Territories&lt;\/option&gt;\n&lt;option value=&quot;53&quot;&gt;Yunnan&lt;\/option&gt;\n&lt;option value=&quot;ZA&quot;&gt;Zacatecas&lt;\/option&gt;\n&lt;option value=&quot;33&quot;&gt;Zhejiang&lt;\/option&gt;\n&lt;\/select&gt;&lt;br&gt;\n\n&lt;div class=&quot;g-recaptcha&quot; data-sitekey=&quot;6LfK3zIsAAAAAHbD6tKvW49GfwlbCRnOU_Sk9olG&quot;&gt;&lt;\/div&gt;&lt;br&gt;\n&lt;input type=&quot;submit&quot; name=&quot;submit&quot;&gt;\n\n&lt;\/form&gt;\n<\/code><\/pre>\n\n\n\n<pre class=\"wp-block-code\"><code>\nAdoption Application\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: Please add the following &lt;META&gt; element to your page &lt;HEAD&gt;.      --&gt;\n&lt;!--  If necessary, please modify the charset parameter to specify the        --&gt;\n&lt;!--  character set of your HTML page.                                        --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;meta http-equiv=&quot;Content-type&quot; content=&quot;text\/html; charset=UTF-8&quot;&gt;\n&lt;script src=&quot;https:\/\/www.google.com\/recaptcha\/api.js&quot;&gt;&lt;\/script&gt;\n&lt;script&gt;\n function timestamp() { var response = document.getElementById(&quot;g-recaptcha-response&quot;); if (response == null || response.value.trim() == &quot;&quot;) {var elems = JSON.parse(document.getElementsByName(&quot;captcha_settings&quot;)[0].value);elems[&quot;ts&quot;] = JSON.stringify(new Date().getTime());document.getElementsByName(&quot;captcha_settings&quot;)[0].value = JSON.stringify(elems); } } setInterval(timestamp, 500); \n&lt;\/script&gt;\n\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: Please add the following &lt;FORM&gt; element to your page.             --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;form action=&quot;https:\/\/webto.salesforce.com\/servlet\/servlet.WebToLead?encoding=UTF-8&amp;orgId=00D0900000EA4YZ&quot; method=&quot;POST&quot;&gt;\n\n&lt;input type=&quot;hidden&quot; name=&#039;captcha_settings&#039; value=&#039;{&quot;keyname&quot;:&quot;NewParent&quot;,&quot;fallback&quot;:&quot;true&quot;,&quot;orgId&quot;:&quot;00D0900000EA4YZ&quot;,&quot;ts&quot;:&quot;&quot;}&#039;&gt;\n&lt;input type=&quot;hidden&quot; name=&quot;oid&quot; value=&quot;00D0900000EA4YZ&quot;&gt;\n&lt;input type=&quot;hidden&quot; name=&quot;retURL&quot; value=&quot;https:\/\/bestiesplit.hr\/thank-you-for-your-application\/&quot;&gt;\n\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: These fields are optional debugging elements. Please uncomment    --&gt;\n&lt;!--  these lines if you wish to test in debug mode.                          --&gt;\n&lt;!--  &lt;input type=&quot;hidden&quot; name=&quot;debug&quot; value=1&gt;                              --&gt;\n&lt;!--  &lt;input type=&quot;hidden&quot; name=&quot;debugEmail&quot;                                  --&gt;\n&lt;!--  value=&quot;lauriebayles1@gmail.com&quot;&gt;                                        --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;label for=&quot;first_name&quot;&gt;First Name&lt;\/label&gt;&lt;input  id=&quot;first_name&quot; maxlength=&quot;40&quot; name=&quot;first_name&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;last_name&quot;&gt;Last Name&lt;\/label&gt;&lt;input  id=&quot;last_name&quot; maxlength=&quot;80&quot; name=&quot;last_name&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;email&quot;&gt;Email&lt;\/label&gt;&lt;input  id=&quot;email&quot; maxlength=&quot;80&quot; name=&quot;email&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;company&quot;&gt;Company&lt;\/label&gt;&lt;input  id=&quot;company&quot; maxlength=&quot;40&quot; name=&quot;company&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;city&quot;&gt;City&lt;\/label&gt;&lt;input  id=&quot;city&quot; maxlength=&quot;40&quot; name=&quot;city&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;country_code&quot;&gt;Country&lt;\/label&gt;&lt;select  id=&quot;country_code&quot; name=&quot;country_code&quot;&gt;&lt;option value=&quot;&quot;&gt;--None--&lt;\/option&gt;&lt;option value=&quot;AF&quot;&gt;Afghanistan&lt;\/option&gt;\n&lt;option value=&quot;AX&quot;&gt;Aland Islands&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Albania&lt;\/option&gt;\n&lt;option value=&quot;DZ&quot;&gt;Algeria&lt;\/option&gt;\n&lt;option value=&quot;AD&quot;&gt;Andorra&lt;\/option&gt;\n&lt;option value=&quot;AO&quot;&gt;Angola&lt;\/option&gt;\n&lt;option value=&quot;AI&quot;&gt;Anguilla&lt;\/option&gt;\n&lt;option value=&quot;AQ&quot;&gt;Antarctica&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Antigua and Barbuda&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Argentina&lt;\/option&gt;\n&lt;option value=&quot;AM&quot;&gt;Armenia&lt;\/option&gt;\n&lt;option value=&quot;AW&quot;&gt;Aruba&lt;\/option&gt;\n&lt;option value=&quot;AU&quot;&gt;Australia&lt;\/option&gt;\n&lt;option value=&quot;AT&quot;&gt;Austria&lt;\/option&gt;\n&lt;option value=&quot;AZ&quot;&gt;Azerbaijan&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Bahamas&lt;\/option&gt;\n&lt;option value=&quot;BH&quot;&gt;Bahrain&lt;\/option&gt;\n&lt;option value=&quot;BD&quot;&gt;Bangladesh&lt;\/option&gt;\n&lt;option value=&quot;BB&quot;&gt;Barbados&lt;\/option&gt;\n&lt;option value=&quot;BY&quot;&gt;Belarus&lt;\/option&gt;\n&lt;option value=&quot;BE&quot;&gt;Belgium&lt;\/option&gt;\n&lt;option value=&quot;BZ&quot;&gt;Belize&lt;\/option&gt;\n&lt;option value=&quot;BJ&quot;&gt;Benin&lt;\/option&gt;\n&lt;option value=&quot;BM&quot;&gt;Bermuda&lt;\/option&gt;\n&lt;option value=&quot;BT&quot;&gt;Bhutan&lt;\/option&gt;\n&lt;option value=&quot;BO&quot;&gt;Bolivia, Plurinational State of&lt;\/option&gt;\n&lt;option value=&quot;BQ&quot;&gt;Bonaire, Sint Eustatius and Saba&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bosnia and Herzegovina&lt;\/option&gt;\n&lt;option value=&quot;BW&quot;&gt;Botswana&lt;\/option&gt;\n&lt;option value=&quot;BV&quot;&gt;Bouvet Island&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Brazil&lt;\/option&gt;\n&lt;option value=&quot;IO&quot;&gt;British Indian Ocean Territory&lt;\/option&gt;\n&lt;option value=&quot;BN&quot;&gt;Brunei Darussalam&lt;\/option&gt;\n&lt;option value=&quot;BG&quot;&gt;Bulgaria&lt;\/option&gt;\n&lt;option value=&quot;BF&quot;&gt;Burkina Faso&lt;\/option&gt;\n&lt;option value=&quot;BI&quot;&gt;Burundi&lt;\/option&gt;\n&lt;option value=&quot;KH&quot;&gt;Cambodia&lt;\/option&gt;\n&lt;option value=&quot;CM&quot;&gt;Cameroon&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;Canada&lt;\/option&gt;\n&lt;option value=&quot;CV&quot;&gt;Cape Verde&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Cayman Islands&lt;\/option&gt;\n&lt;option value=&quot;CF&quot;&gt;Central African Republic&lt;\/option&gt;\n&lt;option value=&quot;TD&quot;&gt;Chad&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Chile&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;China&lt;\/option&gt;\n&lt;option value=&quot;CX&quot;&gt;Christmas Island&lt;\/option&gt;\n&lt;option value=&quot;CC&quot;&gt;Cocos (Keeling) Islands&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Colombia&lt;\/option&gt;\n&lt;option value=&quot;KM&quot;&gt;Comoros&lt;\/option&gt;\n&lt;option value=&quot;CG&quot;&gt;Congo&lt;\/option&gt;\n&lt;option value=&quot;CD&quot;&gt;Congo, the Democratic Republic of the&lt;\/option&gt;\n&lt;option value=&quot;CK&quot;&gt;Cook Islands&lt;\/option&gt;\n&lt;option value=&quot;CR&quot;&gt;Costa Rica&lt;\/option&gt;\n&lt;option value=&quot;CI&quot;&gt;Cote d&amp;#39;Ivoire&lt;\/option&gt;\n&lt;option value=&quot;HR&quot;&gt;Croatia&lt;\/option&gt;\n&lt;option value=&quot;CU&quot;&gt;Cuba&lt;\/option&gt;\n&lt;option value=&quot;CW&quot;&gt;Cura&ccedil;ao&lt;\/option&gt;\n&lt;option value=&quot;CY&quot;&gt;Cyprus&lt;\/option&gt;\n&lt;option value=&quot;CZ&quot;&gt;Czech Republic&lt;\/option&gt;\n&lt;option value=&quot;DK&quot;&gt;Denmark&lt;\/option&gt;\n&lt;option value=&quot;DJ&quot;&gt;Djibouti&lt;\/option&gt;\n&lt;option value=&quot;DM&quot;&gt;Dominica&lt;\/option&gt;\n&lt;option value=&quot;DO&quot;&gt;Dominican Republic&lt;\/option&gt;\n&lt;option value=&quot;EC&quot;&gt;Ecuador&lt;\/option&gt;\n&lt;option value=&quot;EG&quot;&gt;Egypt&lt;\/option&gt;\n&lt;option value=&quot;SV&quot;&gt;El Salvador&lt;\/option&gt;\n&lt;option value=&quot;GQ&quot;&gt;Equatorial Guinea&lt;\/option&gt;\n&lt;option value=&quot;ER&quot;&gt;Eritrea&lt;\/option&gt;\n&lt;option value=&quot;EE&quot;&gt;Estonia&lt;\/option&gt;\n&lt;option value=&quot;ET&quot;&gt;Ethiopia&lt;\/option&gt;\n&lt;option value=&quot;FK&quot;&gt;Falkland Islands (Malvinas)&lt;\/option&gt;\n&lt;option value=&quot;FO&quot;&gt;Faroe Islands&lt;\/option&gt;\n&lt;option value=&quot;FJ&quot;&gt;Fiji&lt;\/option&gt;\n&lt;option value=&quot;FI&quot;&gt;Finland&lt;\/option&gt;\n&lt;option value=&quot;FR&quot;&gt;France&lt;\/option&gt;\n&lt;option value=&quot;GF&quot;&gt;French Guiana&lt;\/option&gt;\n&lt;option value=&quot;PF&quot;&gt;French Polynesia&lt;\/option&gt;\n&lt;option value=&quot;TF&quot;&gt;French Southern Territories&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Gabon&lt;\/option&gt;\n&lt;option value=&quot;GM&quot;&gt;Gambia&lt;\/option&gt;\n&lt;option value=&quot;GE&quot;&gt;Georgia&lt;\/option&gt;\n&lt;option value=&quot;DE&quot;&gt;Germany&lt;\/option&gt;\n&lt;option value=&quot;GH&quot;&gt;Ghana&lt;\/option&gt;\n&lt;option value=&quot;GI&quot;&gt;Gibraltar&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Greece&lt;\/option&gt;\n&lt;option value=&quot;GL&quot;&gt;Greenland&lt;\/option&gt;\n&lt;option value=&quot;GD&quot;&gt;Grenada&lt;\/option&gt;\n&lt;option value=&quot;GP&quot;&gt;Guadeloupe&lt;\/option&gt;\n&lt;option value=&quot;GT&quot;&gt;Guatemala&lt;\/option&gt;\n&lt;option value=&quot;GG&quot;&gt;Guernsey&lt;\/option&gt;\n&lt;option value=&quot;GN&quot;&gt;Guinea&lt;\/option&gt;\n&lt;option value=&quot;GW&quot;&gt;Guinea-Bissau&lt;\/option&gt;\n&lt;option value=&quot;GY&quot;&gt;Guyana&lt;\/option&gt;\n&lt;option value=&quot;HT&quot;&gt;Haiti&lt;\/option&gt;\n&lt;option value=&quot;HM&quot;&gt;Heard Island and McDonald Islands&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Holy See (Vatican City State)&lt;\/option&gt;\n&lt;option value=&quot;HN&quot;&gt;Honduras&lt;\/option&gt;\n&lt;option value=&quot;HU&quot;&gt;Hungary&lt;\/option&gt;\n&lt;option value=&quot;IS&quot;&gt;Iceland&lt;\/option&gt;\n&lt;option value=&quot;IN&quot;&gt;India&lt;\/option&gt;\n&lt;option value=&quot;ID&quot;&gt;Indonesia&lt;\/option&gt;\n&lt;option value=&quot;IR&quot;&gt;Iran, Islamic Republic of&lt;\/option&gt;\n&lt;option value=&quot;IQ&quot;&gt;Iraq&lt;\/option&gt;\n&lt;option value=&quot;IE&quot;&gt;Ireland&lt;\/option&gt;\n&lt;option value=&quot;IM&quot;&gt;Isle of Man&lt;\/option&gt;\n&lt;option value=&quot;IL&quot;&gt;Israel&lt;\/option&gt;\n&lt;option value=&quot;IT&quot;&gt;Italy&lt;\/option&gt;\n&lt;option value=&quot;JM&quot;&gt;Jamaica&lt;\/option&gt;\n&lt;option value=&quot;JP&quot;&gt;Japan&lt;\/option&gt;\n&lt;option value=&quot;JE&quot;&gt;Jersey&lt;\/option&gt;\n&lt;option value=&quot;JO&quot;&gt;Jordan&lt;\/option&gt;\n&lt;option value=&quot;KZ&quot;&gt;Kazakhstan&lt;\/option&gt;\n&lt;option value=&quot;KE&quot;&gt;Kenya&lt;\/option&gt;\n&lt;option value=&quot;KI&quot;&gt;Kiribati&lt;\/option&gt;\n&lt;option value=&quot;KP&quot;&gt;Korea, Democratic People&amp;#39;s Republic of&lt;\/option&gt;\n&lt;option value=&quot;KR&quot;&gt;Korea, Republic of&lt;\/option&gt;\n&lt;option value=&quot;KW&quot;&gt;Kuwait&lt;\/option&gt;\n&lt;option value=&quot;KG&quot;&gt;Kyrgyzstan&lt;\/option&gt;\n&lt;option value=&quot;LA&quot;&gt;Lao People&amp;#39;s Democratic Republic&lt;\/option&gt;\n&lt;option value=&quot;LV&quot;&gt;Latvia&lt;\/option&gt;\n&lt;option value=&quot;LB&quot;&gt;Lebanon&lt;\/option&gt;\n&lt;option value=&quot;LS&quot;&gt;Lesotho&lt;\/option&gt;\n&lt;option value=&quot;LR&quot;&gt;Liberia&lt;\/option&gt;\n&lt;option value=&quot;LY&quot;&gt;Libya&lt;\/option&gt;\n&lt;option value=&quot;LI&quot;&gt;Liechtenstein&lt;\/option&gt;\n&lt;option value=&quot;LT&quot;&gt;Lithuania&lt;\/option&gt;\n&lt;option value=&quot;LU&quot;&gt;Luxembourg&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Macao&lt;\/option&gt;\n&lt;option value=&quot;MK&quot;&gt;Macedonia, the former Yugoslav Republic of&lt;\/option&gt;\n&lt;option value=&quot;MG&quot;&gt;Madagascar&lt;\/option&gt;\n&lt;option value=&quot;MW&quot;&gt;Malawi&lt;\/option&gt;\n&lt;option value=&quot;MY&quot;&gt;Malaysia&lt;\/option&gt;\n&lt;option value=&quot;MV&quot;&gt;Maldives&lt;\/option&gt;\n&lt;option value=&quot;ML&quot;&gt;Mali&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Malta&lt;\/option&gt;\n&lt;option value=&quot;MQ&quot;&gt;Martinique&lt;\/option&gt;\n&lt;option value=&quot;MR&quot;&gt;Mauritania&lt;\/option&gt;\n&lt;option value=&quot;MU&quot;&gt;Mauritius&lt;\/option&gt;\n&lt;option value=&quot;YT&quot;&gt;Mayotte&lt;\/option&gt;\n&lt;option value=&quot;MX&quot;&gt;Mexico&lt;\/option&gt;\n&lt;option value=&quot;MD&quot;&gt;Moldova, Republic of&lt;\/option&gt;\n&lt;option value=&quot;MC&quot;&gt;Monaco&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Mongolia&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Montenegro&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Montserrat&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Morocco&lt;\/option&gt;\n&lt;option value=&quot;MZ&quot;&gt;Mozambique&lt;\/option&gt;\n&lt;option value=&quot;MM&quot;&gt;Myanmar&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Namibia&lt;\/option&gt;\n&lt;option value=&quot;NR&quot;&gt;Nauru&lt;\/option&gt;\n&lt;option value=&quot;NP&quot;&gt;Nepal&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Netherlands&lt;\/option&gt;\n&lt;option value=&quot;NC&quot;&gt;New Caledonia&lt;\/option&gt;\n&lt;option value=&quot;NZ&quot;&gt;New Zealand&lt;\/option&gt;\n&lt;option value=&quot;NI&quot;&gt;Nicaragua&lt;\/option&gt;\n&lt;option value=&quot;NE&quot;&gt;Niger&lt;\/option&gt;\n&lt;option value=&quot;NG&quot;&gt;Nigeria&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Niue&lt;\/option&gt;\n&lt;option value=&quot;NF&quot;&gt;Norfolk Island&lt;\/option&gt;\n&lt;option value=&quot;NO&quot;&gt;Norway&lt;\/option&gt;\n&lt;option value=&quot;OM&quot;&gt;Oman&lt;\/option&gt;\n&lt;option value=&quot;PK&quot;&gt;Pakistan&lt;\/option&gt;\n&lt;option value=&quot;PS&quot;&gt;Palestine&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Panama&lt;\/option&gt;\n&lt;option value=&quot;PG&quot;&gt;Papua New Guinea&lt;\/option&gt;\n&lt;option value=&quot;PY&quot;&gt;Paraguay&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Peru&lt;\/option&gt;\n&lt;option value=&quot;PH&quot;&gt;Philippines&lt;\/option&gt;\n&lt;option value=&quot;PN&quot;&gt;Pitcairn&lt;\/option&gt;\n&lt;option value=&quot;PL&quot;&gt;Poland&lt;\/option&gt;\n&lt;option value=&quot;PT&quot;&gt;Portugal&lt;\/option&gt;\n&lt;option value=&quot;QA&quot;&gt;Qatar&lt;\/option&gt;\n&lt;option value=&quot;RE&quot;&gt;Reunion&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Romania&lt;\/option&gt;\n&lt;option value=&quot;RU&quot;&gt;Russian Federation&lt;\/option&gt;\n&lt;option value=&quot;RW&quot;&gt;Rwanda&lt;\/option&gt;\n&lt;option value=&quot;BL&quot;&gt;Saint Barth&eacute;lemy&lt;\/option&gt;\n&lt;option value=&quot;SH&quot;&gt;Saint Helena, Ascension and Tristan da Cunha&lt;\/option&gt;\n&lt;option value=&quot;KN&quot;&gt;Saint Kitts and Nevis&lt;\/option&gt;\n&lt;option value=&quot;LC&quot;&gt;Saint Lucia&lt;\/option&gt;\n&lt;option value=&quot;MF&quot;&gt;Saint Martin (French part)&lt;\/option&gt;\n&lt;option value=&quot;PM&quot;&gt;Saint Pierre and Miquelon&lt;\/option&gt;\n&lt;option value=&quot;VC&quot;&gt;Saint Vincent and the Grenadines&lt;\/option&gt;\n&lt;option value=&quot;WS&quot;&gt;Samoa&lt;\/option&gt;\n&lt;option value=&quot;SM&quot;&gt;San Marino&lt;\/option&gt;\n&lt;option value=&quot;ST&quot;&gt;Sao Tome and Principe&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;Saudi Arabia&lt;\/option&gt;\n&lt;option value=&quot;SN&quot;&gt;Senegal&lt;\/option&gt;\n&lt;option value=&quot;RS&quot;&gt;Serbia&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;Seychelles&lt;\/option&gt;\n&lt;option value=&quot;SL&quot;&gt;Sierra Leone&lt;\/option&gt;\n&lt;option value=&quot;SG&quot;&gt;Singapore&lt;\/option&gt;\n&lt;option value=&quot;SX&quot;&gt;Sint Maarten (Dutch part)&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Slovakia&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Slovenia&lt;\/option&gt;\n&lt;option value=&quot;SB&quot;&gt;Solomon Islands&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Somalia&lt;\/option&gt;\n&lt;option value=&quot;ZA&quot;&gt;South Africa&lt;\/option&gt;\n&lt;option value=&quot;GS&quot;&gt;South Georgia and the South Sandwich Islands&lt;\/option&gt;\n&lt;option value=&quot;SS&quot;&gt;South Sudan&lt;\/option&gt;\n&lt;option value=&quot;ES&quot;&gt;Spain&lt;\/option&gt;\n&lt;option value=&quot;LK&quot;&gt;Sri Lanka&lt;\/option&gt;\n&lt;option value=&quot;SD&quot;&gt;Sudan&lt;\/option&gt;\n&lt;option value=&quot;SR&quot;&gt;Suriname&lt;\/option&gt;\n&lt;option value=&quot;SJ&quot;&gt;Svalbard and Jan Mayen&lt;\/option&gt;\n&lt;option value=&quot;SZ&quot;&gt;Swaziland&lt;\/option&gt;\n&lt;option value=&quot;SE&quot;&gt;Sweden&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Switzerland&lt;\/option&gt;\n&lt;option value=&quot;SY&quot;&gt;Syrian Arab Republic&lt;\/option&gt;\n&lt;option value=&quot;TW&quot;&gt;Taiwan&lt;\/option&gt;\n&lt;option value=&quot;TJ&quot;&gt;Tajikistan&lt;\/option&gt;\n&lt;option value=&quot;TZ&quot;&gt;Tanzania, United Republic of&lt;\/option&gt;\n&lt;option value=&quot;TH&quot;&gt;Thailand&lt;\/option&gt;\n&lt;option value=&quot;TL&quot;&gt;Timor-Leste&lt;\/option&gt;\n&lt;option value=&quot;TG&quot;&gt;Togo&lt;\/option&gt;\n&lt;option value=&quot;TK&quot;&gt;Tokelau&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Tonga&lt;\/option&gt;\n&lt;option value=&quot;TT&quot;&gt;Trinidad and Tobago&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tunisia&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Turkey&lt;\/option&gt;\n&lt;option value=&quot;TM&quot;&gt;Turkmenistan&lt;\/option&gt;\n&lt;option value=&quot;TC&quot;&gt;Turks and Caicos Islands&lt;\/option&gt;\n&lt;option value=&quot;TV&quot;&gt;Tuvalu&lt;\/option&gt;\n&lt;option value=&quot;UG&quot;&gt;Uganda&lt;\/option&gt;\n&lt;option value=&quot;UA&quot;&gt;Ukraine&lt;\/option&gt;\n&lt;option value=&quot;AE&quot;&gt;United Arab Emirates&lt;\/option&gt;\n&lt;option value=&quot;GB&quot;&gt;United Kingdom&lt;\/option&gt;\n&lt;option value=&quot;US&quot;&gt;United States&lt;\/option&gt;\n&lt;option value=&quot;UY&quot;&gt;Uruguay&lt;\/option&gt;\n&lt;option value=&quot;UZ&quot;&gt;Uzbekistan&lt;\/option&gt;\n&lt;option value=&quot;VU&quot;&gt;Vanuatu&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Venezuela, Bolivarian Republic of&lt;\/option&gt;\n&lt;option value=&quot;VN&quot;&gt;Vietnam&lt;\/option&gt;\n&lt;option value=&quot;VG&quot;&gt;Virgin Islands, British&lt;\/option&gt;\n&lt;option value=&quot;WF&quot;&gt;Wallis and Futuna&lt;\/option&gt;\n&lt;option value=&quot;EH&quot;&gt;Western Sahara&lt;\/option&gt;\n&lt;option value=&quot;YE&quot;&gt;Yemen&lt;\/option&gt;\n&lt;option value=&quot;ZM&quot;&gt;Zambia&lt;\/option&gt;\n&lt;option value=&quot;ZW&quot;&gt;Zimbabwe&lt;\/option&gt;\n&lt;\/select&gt;&lt;br&gt;\n\n&lt;label for=&quot;state_code&quot;&gt;State\/Province&lt;\/label&gt;&lt;select  id=&quot;state_code&quot; name=&quot;state_code&quot;&gt;&lt;option value=&quot;&quot;&gt;--None--&lt;\/option&gt;&lt;option value=&quot;AC&quot;&gt;Acre&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Agrigento&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Aguascalientes&lt;\/option&gt;\n&lt;option value=&quot;05&quot;&gt;Aichi&lt;\/option&gt;\n&lt;option value=&quot;02&quot;&gt;Akita&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alabama&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alagoas&lt;\/option&gt;\n&lt;option value=&quot;AK&quot;&gt;Alaska&lt;\/option&gt;\n&lt;option value=&quot;AB&quot;&gt;Alberta&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alessandria&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Amap&aacute;&lt;\/option&gt;\n&lt;option value=&quot;AM&quot;&gt;Amazonas&lt;\/option&gt;\n&lt;option value=&quot;AN&quot;&gt;Ancona&lt;\/option&gt;\n&lt;option value=&quot;AN&quot;&gt;Andaman and Nicobar Islands&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Andhra Pradesh&lt;\/option&gt;\n&lt;option value=&quot;34&quot;&gt;Anhui&lt;\/option&gt;\n&lt;option value=&quot;23&quot;&gt;Aomori&lt;\/option&gt;\n&lt;option value=&quot;AO&quot;&gt;Aosta&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arezzo&lt;\/option&gt;\n&lt;option value=&quot;AZ&quot;&gt;Arizona&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arkansas&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arunachal Pradesh&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Ascoli Piceno&lt;\/option&gt;\n&lt;option value=&quot;AS&quot;&gt;Assam&lt;\/option&gt;\n&lt;option value=&quot;AT&quot;&gt;Asti&lt;\/option&gt;\n&lt;option value=&quot;ACT&quot;&gt;Australian Capital Territory&lt;\/option&gt;\n&lt;option value=&quot;AV&quot;&gt;Avellino&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bahia&lt;\/option&gt;\n&lt;option value=&quot;BC&quot;&gt;Baja California&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Baja California Sur&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bari&lt;\/option&gt;\n&lt;option value=&quot;BT&quot;&gt;Barletta-Andria-Trani&lt;\/option&gt;\n&lt;option value=&quot;11&quot;&gt;Beijing&lt;\/option&gt;\n&lt;option value=&quot;BL&quot;&gt;Belluno&lt;\/option&gt;\n&lt;option value=&quot;BN&quot;&gt;Benevento&lt;\/option&gt;\n&lt;option value=&quot;BG&quot;&gt;Bergamo&lt;\/option&gt;\n&lt;option value=&quot;BI&quot;&gt;Biella&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Bihar&lt;\/option&gt;\n&lt;option value=&quot;BO&quot;&gt;Bologna&lt;\/option&gt;\n&lt;option value=&quot;BZ&quot;&gt;Bolzano&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Brescia&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Brindisi&lt;\/option&gt;\n&lt;option value=&quot;BC&quot;&gt;British Columbia&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;Cagliari&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;California&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Caltanissetta&lt;\/option&gt;\n&lt;option value=&quot;CM&quot;&gt;Campeche&lt;\/option&gt;\n&lt;option value=&quot;CB&quot;&gt;Campobasso&lt;\/option&gt;\n&lt;option value=&quot;CI&quot;&gt;Carbonia-Iglesias&lt;\/option&gt;\n&lt;option value=&quot;CW&quot;&gt;Carlow&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Caserta&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Catania&lt;\/option&gt;\n&lt;option value=&quot;CZ&quot;&gt;Catanzaro&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;Cavan&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Cear&aacute;&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chandigarh&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Chhattisgarh&lt;\/option&gt;\n&lt;option value=&quot;CS&quot;&gt;Chiapas&lt;\/option&gt;\n&lt;option value=&quot;12&quot;&gt;Chiba&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chieti&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chihuahua&lt;\/option&gt;\n&lt;option value=&quot;50&quot;&gt;Chongqing&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Clare&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Coahuila&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Colima&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Colorado&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Como&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Connecticut&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Cork&lt;\/option&gt;\n&lt;option value=&quot;CS&quot;&gt;Cosenza&lt;\/option&gt;\n&lt;option value=&quot;CR&quot;&gt;Cremona&lt;\/option&gt;\n&lt;option value=&quot;KR&quot;&gt;Crotone&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;Cuneo&lt;\/option&gt;\n&lt;option value=&quot;DN&quot;&gt;Dadra and Nagar Haveli&lt;\/option&gt;\n&lt;option value=&quot;DD&quot;&gt;Daman and Diu&lt;\/option&gt;\n&lt;option value=&quot;DE&quot;&gt;Delaware&lt;\/option&gt;\n&lt;option value=&quot;DL&quot;&gt;Delhi&lt;\/option&gt;\n&lt;option value=&quot;DC&quot;&gt;District of Columbia&lt;\/option&gt;\n&lt;option value=&quot;DF&quot;&gt;Distrito Federal&lt;\/option&gt;\n&lt;option value=&quot;DL&quot;&gt;Donegal&lt;\/option&gt;\n&lt;option value=&quot;D&quot;&gt;Dublin&lt;\/option&gt;\n&lt;option value=&quot;DG&quot;&gt;Durango&lt;\/option&gt;\n&lt;option value=&quot;38&quot;&gt;Ehime&lt;\/option&gt;\n&lt;option value=&quot;EN&quot;&gt;Enna&lt;\/option&gt;\n&lt;option value=&quot;ES&quot;&gt;Esp&iacute;rito Santo&lt;\/option&gt;\n&lt;option value=&quot;DF&quot;&gt;Federal District&lt;\/option&gt;\n&lt;option value=&quot;FM&quot;&gt;Fermo&lt;\/option&gt;\n&lt;option value=&quot;FE&quot;&gt;Ferrara&lt;\/option&gt;\n&lt;option value=&quot;FI&quot;&gt;Florence&lt;\/option&gt;\n&lt;option value=&quot;FL&quot;&gt;Florida&lt;\/option&gt;\n&lt;option value=&quot;FG&quot;&gt;Foggia&lt;\/option&gt;\n&lt;option value=&quot;FC&quot;&gt;Forl&igrave;-Cesena&lt;\/option&gt;\n&lt;option value=&quot;FR&quot;&gt;Frosinone&lt;\/option&gt;\n&lt;option value=&quot;35&quot;&gt;Fujian&lt;\/option&gt;\n&lt;option value=&quot;18&quot;&gt;Fukui&lt;\/option&gt;\n&lt;option value=&quot;40&quot;&gt;Fukuoka&lt;\/option&gt;\n&lt;option value=&quot;07&quot;&gt;Fukushima&lt;\/option&gt;\n&lt;option value=&quot;G&quot;&gt;Galway&lt;\/option&gt;\n&lt;option value=&quot;62&quot;&gt;Gansu&lt;\/option&gt;\n&lt;option value=&quot;GE&quot;&gt;Genoa&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Georgia&lt;\/option&gt;\n&lt;option value=&quot;21&quot;&gt;Gifu&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Goa&lt;\/option&gt;\n&lt;option value=&quot;GO&quot;&gt;Goi&aacute;s&lt;\/option&gt;\n&lt;option value=&quot;GO&quot;&gt;Gorizia&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Grosseto&lt;\/option&gt;\n&lt;option value=&quot;GT&quot;&gt;Guanajuato&lt;\/option&gt;\n&lt;option value=&quot;44&quot;&gt;Guangdong&lt;\/option&gt;\n&lt;option value=&quot;45&quot;&gt;Guangxi&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Guerrero&lt;\/option&gt;\n&lt;option value=&quot;52&quot;&gt;Guizhou&lt;\/option&gt;\n&lt;option value=&quot;GJ&quot;&gt;Gujarat&lt;\/option&gt;\n&lt;option value=&quot;10&quot;&gt;Gunma&lt;\/option&gt;\n&lt;option value=&quot;46&quot;&gt;Hainan&lt;\/option&gt;\n&lt;option value=&quot;HR&quot;&gt;Haryana&lt;\/option&gt;\n&lt;option value=&quot;HI&quot;&gt;Hawaii&lt;\/option&gt;\n&lt;option value=&quot;13&quot;&gt;Hebei&lt;\/option&gt;\n&lt;option value=&quot;23&quot;&gt;Heilongjiang&lt;\/option&gt;\n&lt;option value=&quot;41&quot;&gt;Henan&lt;\/option&gt;\n&lt;option value=&quot;HG&quot;&gt;Hidalgo&lt;\/option&gt;\n&lt;option value=&quot;HP&quot;&gt;Himachal Pradesh&lt;\/option&gt;\n&lt;option value=&quot;34&quot;&gt;Hiroshima&lt;\/option&gt;\n&lt;option value=&quot;01&quot;&gt;Hokkaido&lt;\/option&gt;\n&lt;option value=&quot;91&quot;&gt;Hong Kong&lt;\/option&gt;\n&lt;option value=&quot;42&quot;&gt;Hubei&lt;\/option&gt;\n&lt;option value=&quot;43&quot;&gt;Hunan&lt;\/option&gt;\n&lt;option value=&quot;28&quot;&gt;Hyogo&lt;\/option&gt;\n&lt;option value=&quot;08&quot;&gt;Ibaraki&lt;\/option&gt;\n&lt;option value=&quot;ID&quot;&gt;Idaho&lt;\/option&gt;\n&lt;option value=&quot;IL&quot;&gt;Illinois&lt;\/option&gt;\n&lt;option value=&quot;IM&quot;&gt;Imperia&lt;\/option&gt;\n&lt;option value=&quot;IN&quot;&gt;Indiana&lt;\/option&gt;\n&lt;option value=&quot;IA&quot;&gt;Iowa&lt;\/option&gt;\n&lt;option value=&quot;IS&quot;&gt;Isernia&lt;\/option&gt;\n&lt;option value=&quot;17&quot;&gt;Ishikawa&lt;\/option&gt;\n&lt;option value=&quot;03&quot;&gt;Iwate&lt;\/option&gt;\n&lt;option value=&quot;JA&quot;&gt;Jalisco&lt;\/option&gt;\n&lt;option value=&quot;JK&quot;&gt;Jammu and Kashmir&lt;\/option&gt;\n&lt;option value=&quot;JH&quot;&gt;Jharkhand&lt;\/option&gt;\n&lt;option value=&quot;32&quot;&gt;Jiangsu&lt;\/option&gt;\n&lt;option value=&quot;36&quot;&gt;Jiangxi&lt;\/option&gt;\n&lt;option value=&quot;22&quot;&gt;Jilin&lt;\/option&gt;\n&lt;option value=&quot;37&quot;&gt;Kagawa&lt;\/option&gt;\n&lt;option value=&quot;46&quot;&gt;Kagoshima&lt;\/option&gt;\n&lt;option value=&quot;14&quot;&gt;Kanagawa&lt;\/option&gt;\n&lt;option value=&quot;KS&quot;&gt;Kansas&lt;\/option&gt;\n&lt;option value=&quot;KA&quot;&gt;Karnataka&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Kentucky&lt;\/option&gt;\n&lt;option value=&quot;KL&quot;&gt;Kerala&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Kerry&lt;\/option&gt;\n&lt;option value=&quot;KE&quot;&gt;Kildare&lt;\/option&gt;\n&lt;option value=&quot;KK&quot;&gt;Kilkenny&lt;\/option&gt;\n&lt;option value=&quot;39&quot;&gt;Kochi&lt;\/option&gt;\n&lt;option value=&quot;43&quot;&gt;Kumamoto&lt;\/option&gt;\n&lt;option value=&quot;26&quot;&gt;Kyoto&lt;\/option&gt;\n&lt;option value=&quot;AQ&quot;&gt;L&amp;#39;Aquila&lt;\/option&gt;\n&lt;option value=&quot;LD&quot;&gt;Lakshadweep&lt;\/option&gt;\n&lt;option value=&quot;LS&quot;&gt;Laois&lt;\/option&gt;\n&lt;option value=&quot;SP&quot;&gt;La Spezia&lt;\/option&gt;\n&lt;option value=&quot;LT&quot;&gt;Latina&lt;\/option&gt;\n&lt;option value=&quot;LE&quot;&gt;Lecce&lt;\/option&gt;\n&lt;option value=&quot;LC&quot;&gt;Lecco&lt;\/option&gt;\n&lt;option value=&quot;LM&quot;&gt;Leitrim&lt;\/option&gt;\n&lt;option value=&quot;21&quot;&gt;Liaoning&lt;\/option&gt;\n&lt;option value=&quot;LK&quot;&gt;Limerick&lt;\/option&gt;\n&lt;option value=&quot;LI&quot;&gt;Livorno&lt;\/option&gt;\n&lt;option value=&quot;LO&quot;&gt;Lodi&lt;\/option&gt;\n&lt;option value=&quot;LD&quot;&gt;Longford&lt;\/option&gt;\n&lt;option value=&quot;LA&quot;&gt;Louisiana&lt;\/option&gt;\n&lt;option value=&quot;LH&quot;&gt;Louth&lt;\/option&gt;\n&lt;option value=&quot;LU&quot;&gt;Lucca&lt;\/option&gt;\n&lt;option value=&quot;92&quot;&gt;Macao&lt;\/option&gt;\n&lt;option value=&quot;MC&quot;&gt;Macerata&lt;\/option&gt;\n&lt;option value=&quot;MP&quot;&gt;Madhya Pradesh&lt;\/option&gt;\n&lt;option value=&quot;MH&quot;&gt;Maharashtra&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Maine&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Manipur&lt;\/option&gt;\n&lt;option value=&quot;MB&quot;&gt;Manitoba&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Mantua&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Maranh&atilde;o&lt;\/option&gt;\n&lt;option value=&quot;MD&quot;&gt;Maryland&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Massa and Carrara&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Massachusetts&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Matera&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Mato Grosso&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Mato Grosso do Sul&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Mayo&lt;\/option&gt;\n&lt;option value=&quot;MH&quot;&gt;Meath&lt;\/option&gt;\n&lt;option value=&quot;VS&quot;&gt;Medio Campidano&lt;\/option&gt;\n&lt;option value=&quot;ML&quot;&gt;Meghalaya&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Messina&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Mexico State&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Michigan&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Michoac&aacute;n&lt;\/option&gt;\n&lt;option value=&quot;24&quot;&gt;Mie&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Milan&lt;\/option&gt;\n&lt;option value=&quot;MG&quot;&gt;Minas Gerais&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Minnesota&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Mississippi&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Missouri&lt;\/option&gt;\n&lt;option value=&quot;04&quot;&gt;Miyagi&lt;\/option&gt;\n&lt;option value=&quot;45&quot;&gt;Miyazaki&lt;\/option&gt;\n&lt;option value=&quot;MZ&quot;&gt;Mizoram&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Modena&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Monaghan&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Montana&lt;\/option&gt;\n&lt;option value=&quot;MB&quot;&gt;Monza and Brianza&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Morelos&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Nagaland&lt;\/option&gt;\n&lt;option value=&quot;20&quot;&gt;Nagano&lt;\/option&gt;\n&lt;option value=&quot;42&quot;&gt;Nagasaki&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Naples&lt;\/option&gt;\n&lt;option value=&quot;29&quot;&gt;Nara&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Nayarit&lt;\/option&gt;\n&lt;option value=&quot;NE&quot;&gt;Nebraska&lt;\/option&gt;\n&lt;option value=&quot;15&quot;&gt;Nei Mongol&lt;\/option&gt;\n&lt;option value=&quot;NV&quot;&gt;Nevada&lt;\/option&gt;\n&lt;option value=&quot;NB&quot;&gt;New Brunswick&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Newfoundland and Labrador&lt;\/option&gt;\n&lt;option value=&quot;NH&quot;&gt;New Hampshire&lt;\/option&gt;\n&lt;option value=&quot;NJ&quot;&gt;New Jersey&lt;\/option&gt;\n&lt;option value=&quot;NM&quot;&gt;New Mexico&lt;\/option&gt;\n&lt;option value=&quot;NSW&quot;&gt;New South Wales&lt;\/option&gt;\n&lt;option value=&quot;NY&quot;&gt;New York&lt;\/option&gt;\n&lt;option value=&quot;15&quot;&gt;Niigata&lt;\/option&gt;\n&lt;option value=&quot;64&quot;&gt;Ningxia&lt;\/option&gt;\n&lt;option value=&quot;NC&quot;&gt;North Carolina&lt;\/option&gt;\n&lt;option value=&quot;ND&quot;&gt;North Dakota&lt;\/option&gt;\n&lt;option value=&quot;NT&quot;&gt;Northern Territory&lt;\/option&gt;\n&lt;option value=&quot;NT&quot;&gt;Northwest Territories&lt;\/option&gt;\n&lt;option value=&quot;NO&quot;&gt;Novara&lt;\/option&gt;\n&lt;option value=&quot;NS&quot;&gt;Nova Scotia&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Nuevo Le&oacute;n&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Nunavut&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Nuoro&lt;\/option&gt;\n&lt;option value=&quot;OA&quot;&gt;Oaxaca&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Odisha&lt;\/option&gt;\n&lt;option value=&quot;OY&quot;&gt;Offaly&lt;\/option&gt;\n&lt;option value=&quot;OG&quot;&gt;Ogliastra&lt;\/option&gt;\n&lt;option value=&quot;OH&quot;&gt;Ohio&lt;\/option&gt;\n&lt;option value=&quot;44&quot;&gt;Oita&lt;\/option&gt;\n&lt;option value=&quot;33&quot;&gt;Okayama&lt;\/option&gt;\n&lt;option value=&quot;47&quot;&gt;Okinawa&lt;\/option&gt;\n&lt;option value=&quot;OK&quot;&gt;Oklahoma&lt;\/option&gt;\n&lt;option value=&quot;OT&quot;&gt;Olbia-Tempio&lt;\/option&gt;\n&lt;option value=&quot;ON&quot;&gt;Ontario&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Oregon&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Oristano&lt;\/option&gt;\n&lt;option value=&quot;27&quot;&gt;Osaka&lt;\/option&gt;\n&lt;option value=&quot;PD&quot;&gt;Padua&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Palermo&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Par&aacute;&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Para&iacute;ba&lt;\/option&gt;\n&lt;option value=&quot;PR&quot;&gt;Paran&aacute;&lt;\/option&gt;\n&lt;option value=&quot;PR&quot;&gt;Parma&lt;\/option&gt;\n&lt;option value=&quot;PV&quot;&gt;Pavia&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Pennsylvania&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Pernambuco&lt;\/option&gt;\n&lt;option value=&quot;PG&quot;&gt;Perugia&lt;\/option&gt;\n&lt;option value=&quot;PU&quot;&gt;Pesaro and Urbino&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Pescara&lt;\/option&gt;\n&lt;option value=&quot;PC&quot;&gt;Piacenza&lt;\/option&gt;\n&lt;option value=&quot;PI&quot;&gt;Piau&iacute;&lt;\/option&gt;\n&lt;option value=&quot;PI&quot;&gt;Pisa&lt;\/option&gt;\n&lt;option value=&quot;PT&quot;&gt;Pistoia&lt;\/option&gt;\n&lt;option value=&quot;PN&quot;&gt;Pordenone&lt;\/option&gt;\n&lt;option value=&quot;PZ&quot;&gt;Potenza&lt;\/option&gt;\n&lt;option value=&quot;PO&quot;&gt;Prato&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Prince Edward Island&lt;\/option&gt;\n&lt;option value=&quot;PY&quot;&gt;Puducherry&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Puebla&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Punjab&lt;\/option&gt;\n&lt;option value=&quot;63&quot;&gt;Qinghai&lt;\/option&gt;\n&lt;option value=&quot;QC&quot;&gt;Quebec&lt;\/option&gt;\n&lt;option value=&quot;QLD&quot;&gt;Queensland&lt;\/option&gt;\n&lt;option value=&quot;QE&quot;&gt;Quer&eacute;taro&lt;\/option&gt;\n&lt;option value=&quot;QR&quot;&gt;Quintana Roo&lt;\/option&gt;\n&lt;option value=&quot;RG&quot;&gt;Ragusa&lt;\/option&gt;\n&lt;option value=&quot;RJ&quot;&gt;Rajasthan&lt;\/option&gt;\n&lt;option value=&quot;RA&quot;&gt;Ravenna&lt;\/option&gt;\n&lt;option value=&quot;RC&quot;&gt;Reggio Calabria&lt;\/option&gt;\n&lt;option value=&quot;RE&quot;&gt;Reggio Emilia&lt;\/option&gt;\n&lt;option value=&quot;RI&quot;&gt;Rhode Island&lt;\/option&gt;\n&lt;option value=&quot;RI&quot;&gt;Rieti&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Rimini&lt;\/option&gt;\n&lt;option value=&quot;RJ&quot;&gt;Rio de Janeiro&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Rio Grande do Norte&lt;\/option&gt;\n&lt;option value=&quot;RS&quot;&gt;Rio Grande do Sul&lt;\/option&gt;\n&lt;option value=&quot;RM&quot;&gt;Rome&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Rond&ocirc;nia&lt;\/option&gt;\n&lt;option value=&quot;RR&quot;&gt;Roraima&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Roscommon&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Rovigo&lt;\/option&gt;\n&lt;option value=&quot;41&quot;&gt;Saga&lt;\/option&gt;\n&lt;option value=&quot;11&quot;&gt;Saitama&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;Salerno&lt;\/option&gt;\n&lt;option value=&quot;SL&quot;&gt;San Luis Potos&iacute;&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;Santa Catarina&lt;\/option&gt;\n&lt;option value=&quot;SP&quot;&gt;S&atilde;o Paulo&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Saskatchewan&lt;\/option&gt;\n&lt;option value=&quot;SS&quot;&gt;Sassari&lt;\/option&gt;\n&lt;option value=&quot;SV&quot;&gt;Savona&lt;\/option&gt;\n&lt;option value=&quot;SE&quot;&gt;Sergipe&lt;\/option&gt;\n&lt;option value=&quot;61&quot;&gt;Shaanxi&lt;\/option&gt;\n&lt;option value=&quot;37&quot;&gt;Shandong&lt;\/option&gt;\n&lt;option value=&quot;31&quot;&gt;Shanghai&lt;\/option&gt;\n&lt;option value=&quot;14&quot;&gt;Shanxi&lt;\/option&gt;\n&lt;option value=&quot;25&quot;&gt;Shiga&lt;\/option&gt;\n&lt;option value=&quot;32&quot;&gt;Shimane&lt;\/option&gt;\n&lt;option value=&quot;22&quot;&gt;Shizuoka&lt;\/option&gt;\n&lt;option value=&quot;51&quot;&gt;Sichuan&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Siena&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Sikkim&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Sinaloa&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sligo&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sondrio&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sonora&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;South Australia&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;South Carolina&lt;\/option&gt;\n&lt;option value=&quot;SD&quot;&gt;South Dakota&lt;\/option&gt;\n&lt;option value=&quot;SR&quot;&gt;Syracuse&lt;\/option&gt;\n&lt;option value=&quot;TB&quot;&gt;Tabasco&lt;\/option&gt;\n&lt;option value=&quot;71&quot;&gt;Taiwan&lt;\/option&gt;\n&lt;option value=&quot;TM&quot;&gt;Tamaulipas&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tamil Nadu&lt;\/option&gt;\n&lt;option value=&quot;TA&quot;&gt;Taranto&lt;\/option&gt;\n&lt;option value=&quot;TAS&quot;&gt;Tasmania&lt;\/option&gt;\n&lt;option value=&quot;TG&quot;&gt;Telangana&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tennessee&lt;\/option&gt;\n&lt;option value=&quot;TE&quot;&gt;Teramo&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Terni&lt;\/option&gt;\n&lt;option value=&quot;TX&quot;&gt;Texas&lt;\/option&gt;\n&lt;option value=&quot;12&quot;&gt;Tianjin&lt;\/option&gt;\n&lt;option value=&quot;TA&quot;&gt;Tipperary&lt;\/option&gt;\n&lt;option value=&quot;TL&quot;&gt;Tlaxcala&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Tocantins&lt;\/option&gt;\n&lt;option value=&quot;09&quot;&gt;Tochigi&lt;\/option&gt;\n&lt;option value=&quot;36&quot;&gt;Tokushima&lt;\/option&gt;\n&lt;option value=&quot;13&quot;&gt;Tokyo&lt;\/option&gt;\n&lt;option value=&quot;31&quot;&gt;Tottori&lt;\/option&gt;\n&lt;option value=&quot;16&quot;&gt;Toyama&lt;\/option&gt;\n&lt;option value=&quot;TP&quot;&gt;Trapani&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Trento&lt;\/option&gt;\n&lt;option value=&quot;TV&quot;&gt;Treviso&lt;\/option&gt;\n&lt;option value=&quot;TS&quot;&gt;Trieste&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Tripura&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Turin&lt;\/option&gt;\n&lt;option value=&quot;UD&quot;&gt;Udine&lt;\/option&gt;\n&lt;option value=&quot;UT&quot;&gt;Utah&lt;\/option&gt;\n&lt;option value=&quot;UT&quot;&gt;Uttarakhand&lt;\/option&gt;\n&lt;option value=&quot;UP&quot;&gt;Uttar Pradesh&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Varese&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Venice&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Veracruz&lt;\/option&gt;\n&lt;option value=&quot;VB&quot;&gt;Verbano-Cusio-Ossola&lt;\/option&gt;\n&lt;option value=&quot;VC&quot;&gt;Vercelli&lt;\/option&gt;\n&lt;option value=&quot;VT&quot;&gt;Vermont&lt;\/option&gt;\n&lt;option value=&quot;VR&quot;&gt;Verona&lt;\/option&gt;\n&lt;option value=&quot;VV&quot;&gt;Vibo Valentia&lt;\/option&gt;\n&lt;option value=&quot;VI&quot;&gt;Vicenza&lt;\/option&gt;\n&lt;option value=&quot;VIC&quot;&gt;Victoria&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Virginia&lt;\/option&gt;\n&lt;option value=&quot;VT&quot;&gt;Viterbo&lt;\/option&gt;\n&lt;option value=&quot;30&quot;&gt;Wakayama&lt;\/option&gt;\n&lt;option value=&quot;WA&quot;&gt;Washington&lt;\/option&gt;\n&lt;option value=&quot;WD&quot;&gt;Waterford&lt;\/option&gt;\n&lt;option value=&quot;WB&quot;&gt;West Bengal&lt;\/option&gt;\n&lt;option value=&quot;WA&quot;&gt;Western Australia&lt;\/option&gt;\n&lt;option value=&quot;WH&quot;&gt;Westmeath&lt;\/option&gt;\n&lt;option value=&quot;WV&quot;&gt;West Virginia&lt;\/option&gt;\n&lt;option value=&quot;WX&quot;&gt;Wexford&lt;\/option&gt;\n&lt;option value=&quot;WW&quot;&gt;Wicklow&lt;\/option&gt;\n&lt;option value=&quot;WI&quot;&gt;Wisconsin&lt;\/option&gt;\n&lt;option value=&quot;WY&quot;&gt;Wyoming&lt;\/option&gt;\n&lt;option value=&quot;65&quot;&gt;Xinjiang&lt;\/option&gt;\n&lt;option value=&quot;54&quot;&gt;Xizang&lt;\/option&gt;\n&lt;option value=&quot;06&quot;&gt;Yamagata&lt;\/option&gt;\n&lt;option value=&quot;35&quot;&gt;Yamaguchi&lt;\/option&gt;\n&lt;option value=&quot;19&quot;&gt;Yamanashi&lt;\/option&gt;\n&lt;option value=&quot;YU&quot;&gt;Yucat&aacute;n&lt;\/option&gt;\n&lt;option value=&quot;YT&quot;&gt;Yukon Territories&lt;\/option&gt;\n&lt;option value=&quot;53&quot;&gt;Yunnan&lt;\/option&gt;\n&lt;option value=&quot;ZA&quot;&gt;Zacatecas&lt;\/option&gt;\n&lt;option value=&quot;33&quot;&gt;Zhejiang&lt;\/option&gt;\n&lt;\/select&gt;&lt;br&gt;\n\n&lt;div class=&quot;g-recaptcha&quot; data-sitekey=&quot;6LfK3zIsAAAAAHbD6tKvW49GfwlbCRnOU_Sk9olG&quot;&gt;&lt;\/div&gt;&lt;br&gt;\n&lt;input type=&quot;submit&quot; name=&quot;submit&quot;&gt;\n\n&lt;\/form&gt;<\/code><\/pre>\n\n\n\n<pre class=\"wp-block-code\"><code>&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: Please add the following &lt;META&gt; element to your page &lt;HEAD&gt;.      --&gt;\n&lt;!--  If necessary, please modify the charset parameter to specify the        --&gt;\n&lt;!--  character set of your HTML page.                                        --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;meta http-equiv=&quot;Content-type&quot; content=&quot;text\/html; charset=UTF-8&quot;&gt;\n&lt;script src=&quot;https:\/\/www.google.com\/recaptcha\/api.js&quot;&gt;&lt;\/script&gt;\n&lt;script&gt;\n function timestamp() { var response = document.getElementById(&quot;g-recaptcha-response&quot;); if (response == null || response.value.trim() == &quot;&quot;) {var elems = JSON.parse(document.getElementsByName(&quot;captcha_settings&quot;)[0].value);elems[&quot;ts&quot;] = JSON.stringify(new Date().getTime());document.getElementsByName(&quot;captcha_settings&quot;)[0].value = JSON.stringify(elems); } } setInterval(timestamp, 500); \n&lt;\/script&gt;\n\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: Please add the following &lt;FORM&gt; element to your page.             --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;form action=&quot;https:\/\/webto.salesforce.com\/servlet\/servlet.WebToLead?encoding=UTF-8&amp;orgId=00D0900000EA4YZ&quot; method=&quot;POST&quot;&gt;\n\n&lt;input type=&quot;hidden&quot; name=&#039;captcha_settings&#039; value=&#039;{&quot;keyname&quot;:&quot;NewParent&quot;,&quot;fallback&quot;:&quot;true&quot;,&quot;orgId&quot;:&quot;00D0900000EA4YZ&quot;,&quot;ts&quot;:&quot;&quot;}&#039;&gt;\n&lt;input type=&quot;hidden&quot; name=&quot;oid&quot; value=&quot;00D0900000EA4YZ&quot;&gt;\n&lt;input type=&quot;hidden&quot; name=&quot;retURL&quot; value=&quot;https:\/\/bestiesplit.hr\/thank-you-for-your-application\/&quot;&gt;\n\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: These fields are optional debugging elements. Please uncomment    --&gt;\n&lt;!--  these lines if you wish to test in debug mode.                          --&gt;\n&lt;!--  &lt;input type=&quot;hidden&quot; name=&quot;debug&quot; value=1&gt;                              --&gt;\n&lt;!--  &lt;input type=&quot;hidden&quot; name=&quot;debugEmail&quot;                                  --&gt;\n&lt;!--  value=&quot;lauriebayles1@gmail.com&quot;&gt;                                        --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;label for=&quot;first_name&quot;&gt;First Name&lt;\/label&gt;&lt;input  id=&quot;first_name&quot; maxlength=&quot;40&quot; name=&quot;first_name&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;last_name&quot;&gt;Last Name&lt;\/label&gt;&lt;input  id=&quot;last_name&quot; maxlength=&quot;80&quot; name=&quot;last_name&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;email&quot;&gt;Email&lt;\/label&gt;&lt;input  id=&quot;email&quot; maxlength=&quot;80&quot; name=&quot;email&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;company&quot;&gt;Company&lt;\/label&gt;&lt;input  id=&quot;company&quot; maxlength=&quot;40&quot; name=&quot;company&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;city&quot;&gt;City&lt;\/label&gt;&lt;input  id=&quot;city&quot; maxlength=&quot;40&quot; name=&quot;city&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;country_code&quot;&gt;Country&lt;\/label&gt;&lt;select  id=&quot;country_code&quot; name=&quot;country_code&quot;&gt;&lt;option value=&quot;&quot;&gt;--None--&lt;\/option&gt;&lt;option value=&quot;AF&quot;&gt;Afghanistan&lt;\/option&gt;\n&lt;option value=&quot;AX&quot;&gt;Aland Islands&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Albania&lt;\/option&gt;\n&lt;option value=&quot;DZ&quot;&gt;Algeria&lt;\/option&gt;\n&lt;option value=&quot;AD&quot;&gt;Andorra&lt;\/option&gt;\n&lt;option value=&quot;AO&quot;&gt;Angola&lt;\/option&gt;\n&lt;option value=&quot;AI&quot;&gt;Anguilla&lt;\/option&gt;\n&lt;option value=&quot;AQ&quot;&gt;Antarctica&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Antigua and Barbuda&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Argentina&lt;\/option&gt;\n&lt;option value=&quot;AM&quot;&gt;Armenia&lt;\/option&gt;\n&lt;option value=&quot;AW&quot;&gt;Aruba&lt;\/option&gt;\n&lt;option value=&quot;AU&quot;&gt;Australia&lt;\/option&gt;\n&lt;option value=&quot;AT&quot;&gt;Austria&lt;\/option&gt;\n&lt;option value=&quot;AZ&quot;&gt;Azerbaijan&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Bahamas&lt;\/option&gt;\n&lt;option value=&quot;BH&quot;&gt;Bahrain&lt;\/option&gt;\n&lt;option value=&quot;BD&quot;&gt;Bangladesh&lt;\/option&gt;\n&lt;option value=&quot;BB&quot;&gt;Barbados&lt;\/option&gt;\n&lt;option value=&quot;BY&quot;&gt;Belarus&lt;\/option&gt;\n&lt;option value=&quot;BE&quot;&gt;Belgium&lt;\/option&gt;\n&lt;option value=&quot;BZ&quot;&gt;Belize&lt;\/option&gt;\n&lt;option value=&quot;BJ&quot;&gt;Benin&lt;\/option&gt;\n&lt;option value=&quot;BM&quot;&gt;Bermuda&lt;\/option&gt;\n&lt;option value=&quot;BT&quot;&gt;Bhutan&lt;\/option&gt;\n&lt;option value=&quot;BO&quot;&gt;Bolivia, Plurinational State of&lt;\/option&gt;\n&lt;option value=&quot;BQ&quot;&gt;Bonaire, Sint Eustatius and Saba&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bosnia and Herzegovina&lt;\/option&gt;\n&lt;option value=&quot;BW&quot;&gt;Botswana&lt;\/option&gt;\n&lt;option value=&quot;BV&quot;&gt;Bouvet Island&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Brazil&lt;\/option&gt;\n&lt;option value=&quot;IO&quot;&gt;British Indian Ocean Territory&lt;\/option&gt;\n&lt;option value=&quot;BN&quot;&gt;Brunei Darussalam&lt;\/option&gt;\n&lt;option value=&quot;BG&quot;&gt;Bulgaria&lt;\/option&gt;\n&lt;option value=&quot;BF&quot;&gt;Burkina Faso&lt;\/option&gt;\n&lt;option value=&quot;BI&quot;&gt;Burundi&lt;\/option&gt;\n&lt;option value=&quot;KH&quot;&gt;Cambodia&lt;\/option&gt;\n&lt;option value=&quot;CM&quot;&gt;Cameroon&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;Canada&lt;\/option&gt;\n&lt;option value=&quot;CV&quot;&gt;Cape Verde&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Cayman Islands&lt;\/option&gt;\n&lt;option value=&quot;CF&quot;&gt;Central African Republic&lt;\/option&gt;\n&lt;option value=&quot;TD&quot;&gt;Chad&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Chile&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;China&lt;\/option&gt;\n&lt;option value=&quot;CX&quot;&gt;Christmas Island&lt;\/option&gt;\n&lt;option value=&quot;CC&quot;&gt;Cocos (Keeling) Islands&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Colombia&lt;\/option&gt;\n&lt;option value=&quot;KM&quot;&gt;Comoros&lt;\/option&gt;\n&lt;option value=&quot;CG&quot;&gt;Congo&lt;\/option&gt;\n&lt;option value=&quot;CD&quot;&gt;Congo, the Democratic Republic of the&lt;\/option&gt;\n&lt;option value=&quot;CK&quot;&gt;Cook Islands&lt;\/option&gt;\n&lt;option value=&quot;CR&quot;&gt;Costa Rica&lt;\/option&gt;\n&lt;option value=&quot;CI&quot;&gt;Cote d&amp;#39;Ivoire&lt;\/option&gt;\n&lt;option value=&quot;HR&quot;&gt;Croatia&lt;\/option&gt;\n&lt;option value=&quot;CU&quot;&gt;Cuba&lt;\/option&gt;\n&lt;option value=&quot;CW&quot;&gt;Cura&ccedil;ao&lt;\/option&gt;\n&lt;option value=&quot;CY&quot;&gt;Cyprus&lt;\/option&gt;\n&lt;option value=&quot;CZ&quot;&gt;Czech Republic&lt;\/option&gt;\n&lt;option value=&quot;DK&quot;&gt;Denmark&lt;\/option&gt;\n&lt;option value=&quot;DJ&quot;&gt;Djibouti&lt;\/option&gt;\n&lt;option value=&quot;DM&quot;&gt;Dominica&lt;\/option&gt;\n&lt;option value=&quot;DO&quot;&gt;Dominican Republic&lt;\/option&gt;\n&lt;option value=&quot;EC&quot;&gt;Ecuador&lt;\/option&gt;\n&lt;option value=&quot;EG&quot;&gt;Egypt&lt;\/option&gt;\n&lt;option value=&quot;SV&quot;&gt;El Salvador&lt;\/option&gt;\n&lt;option value=&quot;GQ&quot;&gt;Equatorial Guinea&lt;\/option&gt;\n&lt;option value=&quot;ER&quot;&gt;Eritrea&lt;\/option&gt;\n&lt;option value=&quot;EE&quot;&gt;Estonia&lt;\/option&gt;\n&lt;option value=&quot;ET&quot;&gt;Ethiopia&lt;\/option&gt;\n&lt;option value=&quot;FK&quot;&gt;Falkland Islands (Malvinas)&lt;\/option&gt;\n&lt;option value=&quot;FO&quot;&gt;Faroe Islands&lt;\/option&gt;\n&lt;option value=&quot;FJ&quot;&gt;Fiji&lt;\/option&gt;\n&lt;option value=&quot;FI&quot;&gt;Finland&lt;\/option&gt;\n&lt;option value=&quot;FR&quot;&gt;France&lt;\/option&gt;\n&lt;option value=&quot;GF&quot;&gt;French Guiana&lt;\/option&gt;\n&lt;option value=&quot;PF&quot;&gt;French Polynesia&lt;\/option&gt;\n&lt;option value=&quot;TF&quot;&gt;French Southern Territories&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Gabon&lt;\/option&gt;\n&lt;option value=&quot;GM&quot;&gt;Gambia&lt;\/option&gt;\n&lt;option value=&quot;GE&quot;&gt;Georgia&lt;\/option&gt;\n&lt;option value=&quot;DE&quot;&gt;Germany&lt;\/option&gt;\n&lt;option value=&quot;GH&quot;&gt;Ghana&lt;\/option&gt;\n&lt;option value=&quot;GI&quot;&gt;Gibraltar&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Greece&lt;\/option&gt;\n&lt;option value=&quot;GL&quot;&gt;Greenland&lt;\/option&gt;\n&lt;option value=&quot;GD&quot;&gt;Grenada&lt;\/option&gt;\n&lt;option value=&quot;GP&quot;&gt;Guadeloupe&lt;\/option&gt;\n&lt;option value=&quot;GT&quot;&gt;Guatemala&lt;\/option&gt;\n&lt;option value=&quot;GG&quot;&gt;Guernsey&lt;\/option&gt;\n&lt;option value=&quot;GN&quot;&gt;Guinea&lt;\/option&gt;\n&lt;option value=&quot;GW&quot;&gt;Guinea-Bissau&lt;\/option&gt;\n&lt;option value=&quot;GY&quot;&gt;Guyana&lt;\/option&gt;\n&lt;option value=&quot;HT&quot;&gt;Haiti&lt;\/option&gt;\n&lt;option value=&quot;HM&quot;&gt;Heard Island and McDonald Islands&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Holy See (Vatican City State)&lt;\/option&gt;\n&lt;option value=&quot;HN&quot;&gt;Honduras&lt;\/option&gt;\n&lt;option value=&quot;HU&quot;&gt;Hungary&lt;\/option&gt;\n&lt;option value=&quot;IS&quot;&gt;Iceland&lt;\/option&gt;\n&lt;option value=&quot;IN&quot;&gt;India&lt;\/option&gt;\n&lt;option value=&quot;ID&quot;&gt;Indonesia&lt;\/option&gt;\n&lt;option value=&quot;IR&quot;&gt;Iran, Islamic Republic of&lt;\/option&gt;\n&lt;option value=&quot;IQ&quot;&gt;Iraq&lt;\/option&gt;\n&lt;option value=&quot;IE&quot;&gt;Ireland&lt;\/option&gt;\n&lt;option value=&quot;IM&quot;&gt;Isle of Man&lt;\/option&gt;\n&lt;option value=&quot;IL&quot;&gt;Israel&lt;\/option&gt;\n&lt;option value=&quot;IT&quot;&gt;Italy&lt;\/option&gt;\n&lt;option value=&quot;JM&quot;&gt;Jamaica&lt;\/option&gt;\n&lt;option value=&quot;JP&quot;&gt;Japan&lt;\/option&gt;\n&lt;option value=&quot;JE&quot;&gt;Jersey&lt;\/option&gt;\n&lt;option value=&quot;JO&quot;&gt;Jordan&lt;\/option&gt;\n&lt;option value=&quot;KZ&quot;&gt;Kazakhstan&lt;\/option&gt;\n&lt;option value=&quot;KE&quot;&gt;Kenya&lt;\/option&gt;\n&lt;option value=&quot;KI&quot;&gt;Kiribati&lt;\/option&gt;\n&lt;option value=&quot;KP&quot;&gt;Korea, Democratic People&amp;#39;s Republic of&lt;\/option&gt;\n&lt;option value=&quot;KR&quot;&gt;Korea, Republic of&lt;\/option&gt;\n&lt;option value=&quot;KW&quot;&gt;Kuwait&lt;\/option&gt;\n&lt;option value=&quot;KG&quot;&gt;Kyrgyzstan&lt;\/option&gt;\n&lt;option value=&quot;LA&quot;&gt;Lao People&amp;#39;s Democratic Republic&lt;\/option&gt;\n&lt;option value=&quot;LV&quot;&gt;Latvia&lt;\/option&gt;\n&lt;option value=&quot;LB&quot;&gt;Lebanon&lt;\/option&gt;\n&lt;option value=&quot;LS&quot;&gt;Lesotho&lt;\/option&gt;\n&lt;option value=&quot;LR&quot;&gt;Liberia&lt;\/option&gt;\n&lt;option value=&quot;LY&quot;&gt;Libya&lt;\/option&gt;\n&lt;option value=&quot;LI&quot;&gt;Liechtenstein&lt;\/option&gt;\n&lt;option value=&quot;LT&quot;&gt;Lithuania&lt;\/option&gt;\n&lt;option value=&quot;LU&quot;&gt;Luxembourg&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Macao&lt;\/option&gt;\n&lt;option value=&quot;MK&quot;&gt;Macedonia, the former Yugoslav Republic of&lt;\/option&gt;\n&lt;option value=&quot;MG&quot;&gt;Madagascar&lt;\/option&gt;\n&lt;option value=&quot;MW&quot;&gt;Malawi&lt;\/option&gt;\n&lt;option value=&quot;MY&quot;&gt;Malaysia&lt;\/option&gt;\n&lt;option value=&quot;MV&quot;&gt;Maldives&lt;\/option&gt;\n&lt;option value=&quot;ML&quot;&gt;Mali&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Malta&lt;\/option&gt;\n&lt;option value=&quot;MQ&quot;&gt;Martinique&lt;\/option&gt;\n&lt;option value=&quot;MR&quot;&gt;Mauritania&lt;\/option&gt;\n&lt;option value=&quot;MU&quot;&gt;Mauritius&lt;\/option&gt;\n&lt;option value=&quot;YT&quot;&gt;Mayotte&lt;\/option&gt;\n&lt;option value=&quot;MX&quot;&gt;Mexico&lt;\/option&gt;\n&lt;option value=&quot;MD&quot;&gt;Moldova, Republic of&lt;\/option&gt;\n&lt;option value=&quot;MC&quot;&gt;Monaco&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Mongolia&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Montenegro&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Montserrat&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Morocco&lt;\/option&gt;\n&lt;option value=&quot;MZ&quot;&gt;Mozambique&lt;\/option&gt;\n&lt;option value=&quot;MM&quot;&gt;Myanmar&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Namibia&lt;\/option&gt;\n&lt;option value=&quot;NR&quot;&gt;Nauru&lt;\/option&gt;\n&lt;option value=&quot;NP&quot;&gt;Nepal&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Netherlands&lt;\/option&gt;\n&lt;option value=&quot;NC&quot;&gt;New Caledonia&lt;\/option&gt;\n&lt;option value=&quot;NZ&quot;&gt;New Zealand&lt;\/option&gt;\n&lt;option value=&quot;NI&quot;&gt;Nicaragua&lt;\/option&gt;\n&lt;option value=&quot;NE&quot;&gt;Niger&lt;\/option&gt;\n&lt;option value=&quot;NG&quot;&gt;Nigeria&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Niue&lt;\/option&gt;\n&lt;option value=&quot;NF&quot;&gt;Norfolk Island&lt;\/option&gt;\n&lt;option value=&quot;NO&quot;&gt;Norway&lt;\/option&gt;\n&lt;option value=&quot;OM&quot;&gt;Oman&lt;\/option&gt;\n&lt;option value=&quot;PK&quot;&gt;Pakistan&lt;\/option&gt;\n&lt;option value=&quot;PS&quot;&gt;Palestine&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Panama&lt;\/option&gt;\n&lt;option value=&quot;PG&quot;&gt;Papua New Guinea&lt;\/option&gt;\n&lt;option value=&quot;PY&quot;&gt;Paraguay&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Peru&lt;\/option&gt;\n&lt;option value=&quot;PH&quot;&gt;Philippines&lt;\/option&gt;\n&lt;option value=&quot;PN&quot;&gt;Pitcairn&lt;\/option&gt;\n&lt;option value=&quot;PL&quot;&gt;Poland&lt;\/option&gt;\n&lt;option value=&quot;PT&quot;&gt;Portugal&lt;\/option&gt;\n&lt;option value=&quot;QA&quot;&gt;Qatar&lt;\/option&gt;\n&lt;option value=&quot;RE&quot;&gt;Reunion&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Romania&lt;\/option&gt;\n&lt;option value=&quot;RU&quot;&gt;Russian Federation&lt;\/option&gt;\n&lt;option value=&quot;RW&quot;&gt;Rwanda&lt;\/option&gt;\n&lt;option value=&quot;BL&quot;&gt;Saint Barth&eacute;lemy&lt;\/option&gt;\n&lt;option value=&quot;SH&quot;&gt;Saint Helena, Ascension and Tristan da Cunha&lt;\/option&gt;\n&lt;option value=&quot;KN&quot;&gt;Saint Kitts and Nevis&lt;\/option&gt;\n&lt;option value=&quot;LC&quot;&gt;Saint Lucia&lt;\/option&gt;\n&lt;option value=&quot;MF&quot;&gt;Saint Martin (French part)&lt;\/option&gt;\n&lt;option value=&quot;PM&quot;&gt;Saint Pierre and Miquelon&lt;\/option&gt;\n&lt;option value=&quot;VC&quot;&gt;Saint Vincent and the Grenadines&lt;\/option&gt;\n&lt;option value=&quot;WS&quot;&gt;Samoa&lt;\/option&gt;\n&lt;option value=&quot;SM&quot;&gt;San Marino&lt;\/option&gt;\n&lt;option value=&quot;ST&quot;&gt;Sao Tome and Principe&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;Saudi Arabia&lt;\/option&gt;\n&lt;option value=&quot;SN&quot;&gt;Senegal&lt;\/option&gt;\n&lt;option value=&quot;RS&quot;&gt;Serbia&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;Seychelles&lt;\/option&gt;\n&lt;option value=&quot;SL&quot;&gt;Sierra Leone&lt;\/option&gt;\n&lt;option value=&quot;SG&quot;&gt;Singapore&lt;\/option&gt;\n&lt;option value=&quot;SX&quot;&gt;Sint Maarten (Dutch part)&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Slovakia&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Slovenia&lt;\/option&gt;\n&lt;option value=&quot;SB&quot;&gt;Solomon Islands&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Somalia&lt;\/option&gt;\n&lt;option value=&quot;ZA&quot;&gt;South Africa&lt;\/option&gt;\n&lt;option value=&quot;GS&quot;&gt;South Georgia and the South Sandwich Islands&lt;\/option&gt;\n&lt;option value=&quot;SS&quot;&gt;South Sudan&lt;\/option&gt;\n&lt;option value=&quot;ES&quot;&gt;Spain&lt;\/option&gt;\n&lt;option value=&quot;LK&quot;&gt;Sri Lanka&lt;\/option&gt;\n&lt;option value=&quot;SD&quot;&gt;Sudan&lt;\/option&gt;\n&lt;option value=&quot;SR&quot;&gt;Suriname&lt;\/option&gt;\n&lt;option value=&quot;SJ&quot;&gt;Svalbard and Jan Mayen&lt;\/option&gt;\n&lt;option value=&quot;SZ&quot;&gt;Swaziland&lt;\/option&gt;\n&lt;option value=&quot;SE&quot;&gt;Sweden&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Switzerland&lt;\/option&gt;\n&lt;option value=&quot;SY&quot;&gt;Syrian Arab Republic&lt;\/option&gt;\n&lt;option value=&quot;TW&quot;&gt;Taiwan&lt;\/option&gt;\n&lt;option value=&quot;TJ&quot;&gt;Tajikistan&lt;\/option&gt;\n&lt;option value=&quot;TZ&quot;&gt;Tanzania, United Republic of&lt;\/option&gt;\n&lt;option value=&quot;TH&quot;&gt;Thailand&lt;\/option&gt;\n&lt;option value=&quot;TL&quot;&gt;Timor-Leste&lt;\/option&gt;\n&lt;option value=&quot;TG&quot;&gt;Togo&lt;\/option&gt;\n&lt;option value=&quot;TK&quot;&gt;Tokelau&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Tonga&lt;\/option&gt;\n&lt;option value=&quot;TT&quot;&gt;Trinidad and Tobago&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tunisia&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Turkey&lt;\/option&gt;\n&lt;option value=&quot;TM&quot;&gt;Turkmenistan&lt;\/option&gt;\n&lt;option value=&quot;TC&quot;&gt;Turks and Caicos Islands&lt;\/option&gt;\n&lt;option value=&quot;TV&quot;&gt;Tuvalu&lt;\/option&gt;\n&lt;option value=&quot;UG&quot;&gt;Uganda&lt;\/option&gt;\n&lt;option value=&quot;UA&quot;&gt;Ukraine&lt;\/option&gt;\n&lt;option value=&quot;AE&quot;&gt;United Arab Emirates&lt;\/option&gt;\n&lt;option value=&quot;GB&quot;&gt;United Kingdom&lt;\/option&gt;\n&lt;option value=&quot;US&quot;&gt;United States&lt;\/option&gt;\n&lt;option value=&quot;UY&quot;&gt;Uruguay&lt;\/option&gt;\n&lt;option value=&quot;UZ&quot;&gt;Uzbekistan&lt;\/option&gt;\n&lt;option value=&quot;VU&quot;&gt;Vanuatu&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Venezuela, Bolivarian Republic of&lt;\/option&gt;\n&lt;option value=&quot;VN&quot;&gt;Vietnam&lt;\/option&gt;\n&lt;option value=&quot;VG&quot;&gt;Virgin Islands, British&lt;\/option&gt;\n&lt;option value=&quot;WF&quot;&gt;Wallis and Futuna&lt;\/option&gt;\n&lt;option value=&quot;EH&quot;&gt;Western Sahara&lt;\/option&gt;\n&lt;option value=&quot;YE&quot;&gt;Yemen&lt;\/option&gt;\n&lt;option value=&quot;ZM&quot;&gt;Zambia&lt;\/option&gt;\n&lt;option value=&quot;ZW&quot;&gt;Zimbabwe&lt;\/option&gt;\n&lt;\/select&gt;&lt;br&gt;\n\n&lt;label for=&quot;state_code&quot;&gt;State\/Province&lt;\/label&gt;&lt;select  id=&quot;state_code&quot; name=&quot;state_code&quot;&gt;&lt;option value=&quot;&quot;&gt;--None--&lt;\/option&gt;&lt;option value=&quot;AC&quot;&gt;Acre&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Agrigento&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Aguascalientes&lt;\/option&gt;\n&lt;option value=&quot;05&quot;&gt;Aichi&lt;\/option&gt;\n&lt;option value=&quot;02&quot;&gt;Akita&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alabama&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alagoas&lt;\/option&gt;\n&lt;option value=&quot;AK&quot;&gt;Alaska&lt;\/option&gt;\n&lt;option value=&quot;AB&quot;&gt;Alberta&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alessandria&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Amap&aacute;&lt;\/option&gt;\n&lt;option value=&quot;AM&quot;&gt;Amazonas&lt;\/option&gt;\n&lt;option value=&quot;AN&quot;&gt;Ancona&lt;\/option&gt;\n&lt;option value=&quot;AN&quot;&gt;Andaman and Nicobar Islands&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Andhra Pradesh&lt;\/option&gt;\n&lt;option value=&quot;34&quot;&gt;Anhui&lt;\/option&gt;\n&lt;option value=&quot;23&quot;&gt;Aomori&lt;\/option&gt;\n&lt;option value=&quot;AO&quot;&gt;Aosta&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arezzo&lt;\/option&gt;\n&lt;option value=&quot;AZ&quot;&gt;Arizona&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arkansas&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arunachal Pradesh&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Ascoli Piceno&lt;\/option&gt;\n&lt;option value=&quot;AS&quot;&gt;Assam&lt;\/option&gt;\n&lt;option value=&quot;AT&quot;&gt;Asti&lt;\/option&gt;\n&lt;option value=&quot;ACT&quot;&gt;Australian Capital Territory&lt;\/option&gt;\n&lt;option value=&quot;AV&quot;&gt;Avellino&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bahia&lt;\/option&gt;\n&lt;option value=&quot;BC&quot;&gt;Baja California&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Baja California Sur&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bari&lt;\/option&gt;\n&lt;option value=&quot;BT&quot;&gt;Barletta-Andria-Trani&lt;\/option&gt;\n&lt;option value=&quot;11&quot;&gt;Beijing&lt;\/option&gt;\n&lt;option value=&quot;BL&quot;&gt;Belluno&lt;\/option&gt;\n&lt;option value=&quot;BN&quot;&gt;Benevento&lt;\/option&gt;\n&lt;option value=&quot;BG&quot;&gt;Bergamo&lt;\/option&gt;\n&lt;option value=&quot;BI&quot;&gt;Biella&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Bihar&lt;\/option&gt;\n&lt;option value=&quot;BO&quot;&gt;Bologna&lt;\/option&gt;\n&lt;option value=&quot;BZ&quot;&gt;Bolzano&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Brescia&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Brindisi&lt;\/option&gt;\n&lt;option value=&quot;BC&quot;&gt;British Columbia&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;Cagliari&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;California&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Caltanissetta&lt;\/option&gt;\n&lt;option value=&quot;CM&quot;&gt;Campeche&lt;\/option&gt;\n&lt;option value=&quot;CB&quot;&gt;Campobasso&lt;\/option&gt;\n&lt;option value=&quot;CI&quot;&gt;Carbonia-Iglesias&lt;\/option&gt;\n&lt;option value=&quot;CW&quot;&gt;Carlow&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Caserta&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Catania&lt;\/option&gt;\n&lt;option value=&quot;CZ&quot;&gt;Catanzaro&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;Cavan&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Cear&aacute;&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chandigarh&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Chhattisgarh&lt;\/option&gt;\n&lt;option value=&quot;CS&quot;&gt;Chiapas&lt;\/option&gt;\n&lt;option value=&quot;12&quot;&gt;Chiba&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chieti&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chihuahua&lt;\/option&gt;\n&lt;option value=&quot;50&quot;&gt;Chongqing&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Clare&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Coahuila&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Colima&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Colorado&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Como&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Connecticut&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Cork&lt;\/option&gt;\n&lt;option value=&quot;CS&quot;&gt;Cosenza&lt;\/option&gt;\n&lt;option value=&quot;CR&quot;&gt;Cremona&lt;\/option&gt;\n&lt;option value=&quot;KR&quot;&gt;Crotone&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;Cuneo&lt;\/option&gt;\n&lt;option value=&quot;DN&quot;&gt;Dadra and Nagar Haveli&lt;\/option&gt;\n&lt;option value=&quot;DD&quot;&gt;Daman and Diu&lt;\/option&gt;\n&lt;option value=&quot;DE&quot;&gt;Delaware&lt;\/option&gt;\n&lt;option value=&quot;DL&quot;&gt;Delhi&lt;\/option&gt;\n&lt;option value=&quot;DC&quot;&gt;District of Columbia&lt;\/option&gt;\n&lt;option value=&quot;DF&quot;&gt;Distrito Federal&lt;\/option&gt;\n&lt;option value=&quot;DL&quot;&gt;Donegal&lt;\/option&gt;\n&lt;option value=&quot;D&quot;&gt;Dublin&lt;\/option&gt;\n&lt;option value=&quot;DG&quot;&gt;Durango&lt;\/option&gt;\n&lt;option value=&quot;38&quot;&gt;Ehime&lt;\/option&gt;\n&lt;option value=&quot;EN&quot;&gt;Enna&lt;\/option&gt;\n&lt;option value=&quot;ES&quot;&gt;Esp&iacute;rito Santo&lt;\/option&gt;\n&lt;option value=&quot;DF&quot;&gt;Federal District&lt;\/option&gt;\n&lt;option value=&quot;FM&quot;&gt;Fermo&lt;\/option&gt;\n&lt;option value=&quot;FE&quot;&gt;Ferrara&lt;\/option&gt;\n&lt;option value=&quot;FI&quot;&gt;Florence&lt;\/option&gt;\n&lt;option value=&quot;FL&quot;&gt;Florida&lt;\/option&gt;\n&lt;option value=&quot;FG&quot;&gt;Foggia&lt;\/option&gt;\n&lt;option value=&quot;FC&quot;&gt;Forl&igrave;-Cesena&lt;\/option&gt;\n&lt;option value=&quot;FR&quot;&gt;Frosinone&lt;\/option&gt;\n&lt;option value=&quot;35&quot;&gt;Fujian&lt;\/option&gt;\n&lt;option value=&quot;18&quot;&gt;Fukui&lt;\/option&gt;\n&lt;option value=&quot;40&quot;&gt;Fukuoka&lt;\/option&gt;\n&lt;option value=&quot;07&quot;&gt;Fukushima&lt;\/option&gt;\n&lt;option value=&quot;G&quot;&gt;Galway&lt;\/option&gt;\n&lt;option value=&quot;62&quot;&gt;Gansu&lt;\/option&gt;\n&lt;option value=&quot;GE&quot;&gt;Genoa&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Georgia&lt;\/option&gt;\n&lt;option value=&quot;21&quot;&gt;Gifu&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Goa&lt;\/option&gt;\n&lt;option value=&quot;GO&quot;&gt;Goi&aacute;s&lt;\/option&gt;\n&lt;option value=&quot;GO&quot;&gt;Gorizia&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Grosseto&lt;\/option&gt;\n&lt;option value=&quot;GT&quot;&gt;Guanajuato&lt;\/option&gt;\n&lt;option value=&quot;44&quot;&gt;Guangdong&lt;\/option&gt;\n&lt;option value=&quot;45&quot;&gt;Guangxi&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Guerrero&lt;\/option&gt;\n&lt;option value=&quot;52&quot;&gt;Guizhou&lt;\/option&gt;\n&lt;option value=&quot;GJ&quot;&gt;Gujarat&lt;\/option&gt;\n&lt;option value=&quot;10&quot;&gt;Gunma&lt;\/option&gt;\n&lt;option value=&quot;46&quot;&gt;Hainan&lt;\/option&gt;\n&lt;option value=&quot;HR&quot;&gt;Haryana&lt;\/option&gt;\n&lt;option value=&quot;HI&quot;&gt;Hawaii&lt;\/option&gt;\n&lt;option value=&quot;13&quot;&gt;Hebei&lt;\/option&gt;\n&lt;option value=&quot;23&quot;&gt;Heilongjiang&lt;\/option&gt;\n&lt;option value=&quot;41&quot;&gt;Henan&lt;\/option&gt;\n&lt;option value=&quot;HG&quot;&gt;Hidalgo&lt;\/option&gt;\n&lt;option value=&quot;HP&quot;&gt;Himachal Pradesh&lt;\/option&gt;\n&lt;option value=&quot;34&quot;&gt;Hiroshima&lt;\/option&gt;\n&lt;option value=&quot;01&quot;&gt;Hokkaido&lt;\/option&gt;\n&lt;option value=&quot;91&quot;&gt;Hong Kong&lt;\/option&gt;\n&lt;option value=&quot;42&quot;&gt;Hubei&lt;\/option&gt;\n&lt;option value=&quot;43&quot;&gt;Hunan&lt;\/option&gt;\n&lt;option value=&quot;28&quot;&gt;Hyogo&lt;\/option&gt;\n&lt;option value=&quot;08&quot;&gt;Ibaraki&lt;\/option&gt;\n&lt;option value=&quot;ID&quot;&gt;Idaho&lt;\/option&gt;\n&lt;option value=&quot;IL&quot;&gt;Illinois&lt;\/option&gt;\n&lt;option value=&quot;IM&quot;&gt;Imperia&lt;\/option&gt;\n&lt;option value=&quot;IN&quot;&gt;Indiana&lt;\/option&gt;\n&lt;option value=&quot;IA&quot;&gt;Iowa&lt;\/option&gt;\n&lt;option value=&quot;IS&quot;&gt;Isernia&lt;\/option&gt;\n&lt;option value=&quot;17&quot;&gt;Ishikawa&lt;\/option&gt;\n&lt;option value=&quot;03&quot;&gt;Iwate&lt;\/option&gt;\n&lt;option value=&quot;JA&quot;&gt;Jalisco&lt;\/option&gt;\n&lt;option value=&quot;JK&quot;&gt;Jammu and Kashmir&lt;\/option&gt;\n&lt;option value=&quot;JH&quot;&gt;Jharkhand&lt;\/option&gt;\n&lt;option value=&quot;32&quot;&gt;Jiangsu&lt;\/option&gt;\n&lt;option value=&quot;36&quot;&gt;Jiangxi&lt;\/option&gt;\n&lt;option value=&quot;22&quot;&gt;Jilin&lt;\/option&gt;\n&lt;option value=&quot;37&quot;&gt;Kagawa&lt;\/option&gt;\n&lt;option value=&quot;46&quot;&gt;Kagoshima&lt;\/option&gt;\n&lt;option value=&quot;14&quot;&gt;Kanagawa&lt;\/option&gt;\n&lt;option value=&quot;KS&quot;&gt;Kansas&lt;\/option&gt;\n&lt;option value=&quot;KA&quot;&gt;Karnataka&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Kentucky&lt;\/option&gt;\n&lt;option value=&quot;KL&quot;&gt;Kerala&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Kerry&lt;\/option&gt;\n&lt;option value=&quot;KE&quot;&gt;Kildare&lt;\/option&gt;\n&lt;option value=&quot;KK&quot;&gt;Kilkenny&lt;\/option&gt;\n&lt;option value=&quot;39&quot;&gt;Kochi&lt;\/option&gt;\n&lt;option value=&quot;43&quot;&gt;Kumamoto&lt;\/option&gt;\n&lt;option value=&quot;26&quot;&gt;Kyoto&lt;\/option&gt;\n&lt;option value=&quot;AQ&quot;&gt;L&amp;#39;Aquila&lt;\/option&gt;\n&lt;option value=&quot;LD&quot;&gt;Lakshadweep&lt;\/option&gt;\n&lt;option value=&quot;LS&quot;&gt;Laois&lt;\/option&gt;\n&lt;option value=&quot;SP&quot;&gt;La Spezia&lt;\/option&gt;\n&lt;option value=&quot;LT&quot;&gt;Latina&lt;\/option&gt;\n&lt;option value=&quot;LE&quot;&gt;Lecce&lt;\/option&gt;\n&lt;option value=&quot;LC&quot;&gt;Lecco&lt;\/option&gt;\n&lt;option value=&quot;LM&quot;&gt;Leitrim&lt;\/option&gt;\n&lt;option value=&quot;21&quot;&gt;Liaoning&lt;\/option&gt;\n&lt;option value=&quot;LK&quot;&gt;Limerick&lt;\/option&gt;\n&lt;option value=&quot;LI&quot;&gt;Livorno&lt;\/option&gt;\n&lt;option value=&quot;LO&quot;&gt;Lodi&lt;\/option&gt;\n&lt;option value=&quot;LD&quot;&gt;Longford&lt;\/option&gt;\n&lt;option value=&quot;LA&quot;&gt;Louisiana&lt;\/option&gt;\n&lt;option value=&quot;LH&quot;&gt;Louth&lt;\/option&gt;\n&lt;option value=&quot;LU&quot;&gt;Lucca&lt;\/option&gt;\n&lt;option value=&quot;92&quot;&gt;Macao&lt;\/option&gt;\n&lt;option value=&quot;MC&quot;&gt;Macerata&lt;\/option&gt;\n&lt;option value=&quot;MP&quot;&gt;Madhya Pradesh&lt;\/option&gt;\n&lt;option value=&quot;MH&quot;&gt;Maharashtra&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Maine&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Manipur&lt;\/option&gt;\n&lt;option value=&quot;MB&quot;&gt;Manitoba&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Mantua&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Maranh&atilde;o&lt;\/option&gt;\n&lt;option value=&quot;MD&quot;&gt;Maryland&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Massa and Carrara&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Massachusetts&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Matera&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Mato Grosso&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Mato Grosso do Sul&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Mayo&lt;\/option&gt;\n&lt;option value=&quot;MH&quot;&gt;Meath&lt;\/option&gt;\n&lt;option value=&quot;VS&quot;&gt;Medio Campidano&lt;\/option&gt;\n&lt;option value=&quot;ML&quot;&gt;Meghalaya&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Messina&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Mexico State&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Michigan&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Michoac&aacute;n&lt;\/option&gt;\n&lt;option value=&quot;24&quot;&gt;Mie&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Milan&lt;\/option&gt;\n&lt;option value=&quot;MG&quot;&gt;Minas Gerais&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Minnesota&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Mississippi&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Missouri&lt;\/option&gt;\n&lt;option value=&quot;04&quot;&gt;Miyagi&lt;\/option&gt;\n&lt;option value=&quot;45&quot;&gt;Miyazaki&lt;\/option&gt;\n&lt;option value=&quot;MZ&quot;&gt;Mizoram&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Modena&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Monaghan&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Montana&lt;\/option&gt;\n&lt;option value=&quot;MB&quot;&gt;Monza and Brianza&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Morelos&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Nagaland&lt;\/option&gt;\n&lt;option value=&quot;20&quot;&gt;Nagano&lt;\/option&gt;\n&lt;option value=&quot;42&quot;&gt;Nagasaki&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Naples&lt;\/option&gt;\n&lt;option value=&quot;29&quot;&gt;Nara&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Nayarit&lt;\/option&gt;\n&lt;option value=&quot;NE&quot;&gt;Nebraska&lt;\/option&gt;\n&lt;option value=&quot;15&quot;&gt;Nei Mongol&lt;\/option&gt;\n&lt;option value=&quot;NV&quot;&gt;Nevada&lt;\/option&gt;\n&lt;option value=&quot;NB&quot;&gt;New Brunswick&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Newfoundland and Labrador&lt;\/option&gt;\n&lt;option value=&quot;NH&quot;&gt;New Hampshire&lt;\/option&gt;\n&lt;option value=&quot;NJ&quot;&gt;New Jersey&lt;\/option&gt;\n&lt;option value=&quot;NM&quot;&gt;New Mexico&lt;\/option&gt;\n&lt;option value=&quot;NSW&quot;&gt;New South Wales&lt;\/option&gt;\n&lt;option value=&quot;NY&quot;&gt;New York&lt;\/option&gt;\n&lt;option value=&quot;15&quot;&gt;Niigata&lt;\/option&gt;\n&lt;option value=&quot;64&quot;&gt;Ningxia&lt;\/option&gt;\n&lt;option value=&quot;NC&quot;&gt;North Carolina&lt;\/option&gt;\n&lt;option value=&quot;ND&quot;&gt;North Dakota&lt;\/option&gt;\n&lt;option value=&quot;NT&quot;&gt;Northern Territory&lt;\/option&gt;\n&lt;option value=&quot;NT&quot;&gt;Northwest Territories&lt;\/option&gt;\n&lt;option value=&quot;NO&quot;&gt;Novara&lt;\/option&gt;\n&lt;option value=&quot;NS&quot;&gt;Nova Scotia&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Nuevo Le&oacute;n&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Nunavut&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Nuoro&lt;\/option&gt;\n&lt;option value=&quot;OA&quot;&gt;Oaxaca&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Odisha&lt;\/option&gt;\n&lt;option value=&quot;OY&quot;&gt;Offaly&lt;\/option&gt;\n&lt;option value=&quot;OG&quot;&gt;Ogliastra&lt;\/option&gt;\n&lt;option value=&quot;OH&quot;&gt;Ohio&lt;\/option&gt;\n&lt;option value=&quot;44&quot;&gt;Oita&lt;\/option&gt;\n&lt;option value=&quot;33&quot;&gt;Okayama&lt;\/option&gt;\n&lt;option value=&quot;47&quot;&gt;Okinawa&lt;\/option&gt;\n&lt;option value=&quot;OK&quot;&gt;Oklahoma&lt;\/option&gt;\n&lt;option value=&quot;OT&quot;&gt;Olbia-Tempio&lt;\/option&gt;\n&lt;option value=&quot;ON&quot;&gt;Ontario&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Oregon&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Oristano&lt;\/option&gt;\n&lt;option value=&quot;27&quot;&gt;Osaka&lt;\/option&gt;\n&lt;option value=&quot;PD&quot;&gt;Padua&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Palermo&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Par&aacute;&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Para&iacute;ba&lt;\/option&gt;\n&lt;option value=&quot;PR&quot;&gt;Paran&aacute;&lt;\/option&gt;\n&lt;option value=&quot;PR&quot;&gt;Parma&lt;\/option&gt;\n&lt;option value=&quot;PV&quot;&gt;Pavia&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Pennsylvania&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Pernambuco&lt;\/option&gt;\n&lt;option value=&quot;PG&quot;&gt;Perugia&lt;\/option&gt;\n&lt;option value=&quot;PU&quot;&gt;Pesaro and Urbino&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Pescara&lt;\/option&gt;\n&lt;option value=&quot;PC&quot;&gt;Piacenza&lt;\/option&gt;\n&lt;option value=&quot;PI&quot;&gt;Piau&iacute;&lt;\/option&gt;\n&lt;option value=&quot;PI&quot;&gt;Pisa&lt;\/option&gt;\n&lt;option value=&quot;PT&quot;&gt;Pistoia&lt;\/option&gt;\n&lt;option value=&quot;PN&quot;&gt;Pordenone&lt;\/option&gt;\n&lt;option value=&quot;PZ&quot;&gt;Potenza&lt;\/option&gt;\n&lt;option value=&quot;PO&quot;&gt;Prato&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Prince Edward Island&lt;\/option&gt;\n&lt;option value=&quot;PY&quot;&gt;Puducherry&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Puebla&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Punjab&lt;\/option&gt;\n&lt;option value=&quot;63&quot;&gt;Qinghai&lt;\/option&gt;\n&lt;option value=&quot;QC&quot;&gt;Quebec&lt;\/option&gt;\n&lt;option value=&quot;QLD&quot;&gt;Queensland&lt;\/option&gt;\n&lt;option value=&quot;QE&quot;&gt;Quer&eacute;taro&lt;\/option&gt;\n&lt;option value=&quot;QR&quot;&gt;Quintana Roo&lt;\/option&gt;\n&lt;option value=&quot;RG&quot;&gt;Ragusa&lt;\/option&gt;\n&lt;option value=&quot;RJ&quot;&gt;Rajasthan&lt;\/option&gt;\n&lt;option value=&quot;RA&quot;&gt;Ravenna&lt;\/option&gt;\n&lt;option value=&quot;RC&quot;&gt;Reggio Calabria&lt;\/option&gt;\n&lt;option value=&quot;RE&quot;&gt;Reggio Emilia&lt;\/option&gt;\n&lt;option value=&quot;RI&quot;&gt;Rhode Island&lt;\/option&gt;\n&lt;option value=&quot;RI&quot;&gt;Rieti&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Rimini&lt;\/option&gt;\n&lt;option value=&quot;RJ&quot;&gt;Rio de Janeiro&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Rio Grande do Norte&lt;\/option&gt;\n&lt;option value=&quot;RS&quot;&gt;Rio Grande do Sul&lt;\/option&gt;\n&lt;option value=&quot;RM&quot;&gt;Rome&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Rond&ocirc;nia&lt;\/option&gt;\n&lt;option value=&quot;RR&quot;&gt;Roraima&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Roscommon&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Rovigo&lt;\/option&gt;\n&lt;option value=&quot;41&quot;&gt;Saga&lt;\/option&gt;\n&lt;option value=&quot;11&quot;&gt;Saitama&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;Salerno&lt;\/option&gt;\n&lt;option value=&quot;SL&quot;&gt;San Luis Potos&iacute;&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;Santa Catarina&lt;\/option&gt;\n&lt;option value=&quot;SP&quot;&gt;S&atilde;o Paulo&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Saskatchewan&lt;\/option&gt;\n&lt;option value=&quot;SS&quot;&gt;Sassari&lt;\/option&gt;\n&lt;option value=&quot;SV&quot;&gt;Savona&lt;\/option&gt;\n&lt;option value=&quot;SE&quot;&gt;Sergipe&lt;\/option&gt;\n&lt;option value=&quot;61&quot;&gt;Shaanxi&lt;\/option&gt;\n&lt;option value=&quot;37&quot;&gt;Shandong&lt;\/option&gt;\n&lt;option value=&quot;31&quot;&gt;Shanghai&lt;\/option&gt;\n&lt;option value=&quot;14&quot;&gt;Shanxi&lt;\/option&gt;\n&lt;option value=&quot;25&quot;&gt;Shiga&lt;\/option&gt;\n&lt;option value=&quot;32&quot;&gt;Shimane&lt;\/option&gt;\n&lt;option value=&quot;22&quot;&gt;Shizuoka&lt;\/option&gt;\n&lt;option value=&quot;51&quot;&gt;Sichuan&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Siena&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Sikkim&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Sinaloa&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sligo&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sondrio&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sonora&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;South Australia&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;South Carolina&lt;\/option&gt;\n&lt;option value=&quot;SD&quot;&gt;South Dakota&lt;\/option&gt;\n&lt;option value=&quot;SR&quot;&gt;Syracuse&lt;\/option&gt;\n&lt;option value=&quot;TB&quot;&gt;Tabasco&lt;\/option&gt;\n&lt;option value=&quot;71&quot;&gt;Taiwan&lt;\/option&gt;\n&lt;option value=&quot;TM&quot;&gt;Tamaulipas&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tamil Nadu&lt;\/option&gt;\n&lt;option value=&quot;TA&quot;&gt;Taranto&lt;\/option&gt;\n&lt;option value=&quot;TAS&quot;&gt;Tasmania&lt;\/option&gt;\n&lt;option value=&quot;TG&quot;&gt;Telangana&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tennessee&lt;\/option&gt;\n&lt;option value=&quot;TE&quot;&gt;Teramo&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Terni&lt;\/option&gt;\n&lt;option value=&quot;TX&quot;&gt;Texas&lt;\/option&gt;\n&lt;option value=&quot;12&quot;&gt;Tianjin&lt;\/option&gt;\n&lt;option value=&quot;TA&quot;&gt;Tipperary&lt;\/option&gt;\n&lt;option value=&quot;TL&quot;&gt;Tlaxcala&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Tocantins&lt;\/option&gt;\n&lt;option value=&quot;09&quot;&gt;Tochigi&lt;\/option&gt;\n&lt;option value=&quot;36&quot;&gt;Tokushima&lt;\/option&gt;\n&lt;option value=&quot;13&quot;&gt;Tokyo&lt;\/option&gt;\n&lt;option value=&quot;31&quot;&gt;Tottori&lt;\/option&gt;\n&lt;option value=&quot;16&quot;&gt;Toyama&lt;\/option&gt;\n&lt;option value=&quot;TP&quot;&gt;Trapani&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Trento&lt;\/option&gt;\n&lt;option value=&quot;TV&quot;&gt;Treviso&lt;\/option&gt;\n&lt;option value=&quot;TS&quot;&gt;Trieste&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Tripura&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Turin&lt;\/option&gt;\n&lt;option value=&quot;UD&quot;&gt;Udine&lt;\/option&gt;\n&lt;option value=&quot;UT&quot;&gt;Utah&lt;\/option&gt;\n&lt;option value=&quot;UT&quot;&gt;Uttarakhand&lt;\/option&gt;\n&lt;option value=&quot;UP&quot;&gt;Uttar Pradesh&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Varese&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Venice&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Veracruz&lt;\/option&gt;\n&lt;option value=&quot;VB&quot;&gt;Verbano-Cusio-Ossola&lt;\/option&gt;\n&lt;option value=&quot;VC&quot;&gt;Vercelli&lt;\/option&gt;\n&lt;option value=&quot;VT&quot;&gt;Vermont&lt;\/option&gt;\n&lt;option value=&quot;VR&quot;&gt;Verona&lt;\/option&gt;\n&lt;option value=&quot;VV&quot;&gt;Vibo Valentia&lt;\/option&gt;\n&lt;option value=&quot;VI&quot;&gt;Vicenza&lt;\/option&gt;\n&lt;option value=&quot;VIC&quot;&gt;Victoria&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Virginia&lt;\/option&gt;\n&lt;option value=&quot;VT&quot;&gt;Viterbo&lt;\/option&gt;\n&lt;option value=&quot;30&quot;&gt;Wakayama&lt;\/option&gt;\n&lt;option value=&quot;WA&quot;&gt;Washington&lt;\/option&gt;\n&lt;option value=&quot;WD&quot;&gt;Waterford&lt;\/option&gt;\n&lt;option value=&quot;WB&quot;&gt;West Bengal&lt;\/option&gt;\n&lt;option value=&quot;WA&quot;&gt;Western Australia&lt;\/option&gt;\n&lt;option value=&quot;WH&quot;&gt;Westmeath&lt;\/option&gt;\n&lt;option value=&quot;WV&quot;&gt;West Virginia&lt;\/option&gt;\n&lt;option value=&quot;WX&quot;&gt;Wexford&lt;\/option&gt;\n&lt;option value=&quot;WW&quot;&gt;Wicklow&lt;\/option&gt;\n&lt;option value=&quot;WI&quot;&gt;Wisconsin&lt;\/option&gt;\n&lt;option value=&quot;WY&quot;&gt;Wyoming&lt;\/option&gt;\n&lt;option value=&quot;65&quot;&gt;Xinjiang&lt;\/option&gt;\n&lt;option value=&quot;54&quot;&gt;Xizang&lt;\/option&gt;\n&lt;option value=&quot;06&quot;&gt;Yamagata&lt;\/option&gt;\n&lt;option value=&quot;35&quot;&gt;Yamaguchi&lt;\/option&gt;\n&lt;option value=&quot;19&quot;&gt;Yamanashi&lt;\/option&gt;\n&lt;option value=&quot;YU&quot;&gt;Yucat&aacute;n&lt;\/option&gt;\n&lt;option value=&quot;YT&quot;&gt;Yukon Territories&lt;\/option&gt;\n&lt;option value=&quot;53&quot;&gt;Yunnan&lt;\/option&gt;\n&lt;option value=&quot;ZA&quot;&gt;Zacatecas&lt;\/option&gt;\n&lt;option value=&quot;33&quot;&gt;Zhejiang&lt;\/option&gt;\n&lt;\/select&gt;&lt;br&gt;\n\n&lt;div class=&quot;g-recaptcha&quot; data-sitekey=&quot;6LfK3zIsAAAAAHbD6tKvW49GfwlbCRnOU_Sk9olG&quot;&gt;&lt;\/div&gt;&lt;br&gt;\n&lt;input type=&quot;submit&quot; name=&quot;submit&quot;&gt;\n\n&lt;\/form&gt;\n\nAdoption Application\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: Please add the following &lt;META&gt; element to your page &lt;HEAD&gt;.      --&gt;\n&lt;!--  If necessary, please modify the charset parameter to specify the        --&gt;\n&lt;!--  character set of your HTML page.                                        --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;meta http-equiv=&quot;Content-type&quot; content=&quot;text\/html; charset=UTF-8&quot;&gt;\n&lt;script src=&quot;https:\/\/www.google.com\/recaptcha\/api.js&quot;&gt;&lt;\/script&gt;\n&lt;script&gt;\n function timestamp() { var response = document.getElementById(&quot;g-recaptcha-response&quot;); if (response == null || response.value.trim() == &quot;&quot;) {var elems = JSON.parse(document.getElementsByName(&quot;captcha_settings&quot;)[0].value);elems[&quot;ts&quot;] = JSON.stringify(new Date().getTime());document.getElementsByName(&quot;captcha_settings&quot;)[0].value = JSON.stringify(elems); } } setInterval(timestamp, 500); \n&lt;\/script&gt;\n\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: Please add the following &lt;FORM&gt; element to your page.             --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;form action=&quot;https:\/\/webto.salesforce.com\/servlet\/servlet.WebToLead?encoding=UTF-8&amp;orgId=00D0900000EA4YZ&quot; method=&quot;POST&quot;&gt;\n\n&lt;input type=&quot;hidden&quot; name=&#039;captcha_settings&#039; value=&#039;{&quot;keyname&quot;:&quot;NewParent&quot;,&quot;fallback&quot;:&quot;true&quot;,&quot;orgId&quot;:&quot;00D0900000EA4YZ&quot;,&quot;ts&quot;:&quot;&quot;}&#039;&gt;\n&lt;input type=&quot;hidden&quot; name=&quot;oid&quot; value=&quot;00D0900000EA4YZ&quot;&gt;\n&lt;input type=&quot;hidden&quot; name=&quot;retURL&quot; value=&quot;https:\/\/bestiesplit.hr\/thank-you-for-your-application\/&quot;&gt;\n\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n&lt;!--  NOTE: These fields are optional debugging elements. Please uncomment    --&gt;\n&lt;!--  these lines if you wish to test in debug mode.                          --&gt;\n&lt;!--  &lt;input type=&quot;hidden&quot; name=&quot;debug&quot; value=1&gt;                              --&gt;\n&lt;!--  &lt;input type=&quot;hidden&quot; name=&quot;debugEmail&quot;                                  --&gt;\n&lt;!--  value=&quot;lauriebayles1@gmail.com&quot;&gt;                                        --&gt;\n&lt;!--  ----------------------------------------------------------------------  --&gt;\n\n&lt;label for=&quot;first_name&quot;&gt;First Name&lt;\/label&gt;&lt;input  id=&quot;first_name&quot; maxlength=&quot;40&quot; name=&quot;first_name&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label for=&quot;last_name&quot;&gt;Last Name&lt;\/label&gt;&lt;input  id=&quot;last_name&quot; maxlength=&quot;80&quot; name=&quot;last_name&quot; size=&quot;20&quot; type=&quot;text&quot; \/&gt;&lt;br&gt;\n\n&lt;label 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value=&quot;DZ&quot;&gt;Algeria&lt;\/option&gt;\n&lt;option value=&quot;AD&quot;&gt;Andorra&lt;\/option&gt;\n&lt;option value=&quot;AO&quot;&gt;Angola&lt;\/option&gt;\n&lt;option value=&quot;AI&quot;&gt;Anguilla&lt;\/option&gt;\n&lt;option value=&quot;AQ&quot;&gt;Antarctica&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Antigua and Barbuda&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Argentina&lt;\/option&gt;\n&lt;option value=&quot;AM&quot;&gt;Armenia&lt;\/option&gt;\n&lt;option value=&quot;AW&quot;&gt;Aruba&lt;\/option&gt;\n&lt;option value=&quot;AU&quot;&gt;Australia&lt;\/option&gt;\n&lt;option value=&quot;AT&quot;&gt;Austria&lt;\/option&gt;\n&lt;option value=&quot;AZ&quot;&gt;Azerbaijan&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Bahamas&lt;\/option&gt;\n&lt;option value=&quot;BH&quot;&gt;Bahrain&lt;\/option&gt;\n&lt;option value=&quot;BD&quot;&gt;Bangladesh&lt;\/option&gt;\n&lt;option value=&quot;BB&quot;&gt;Barbados&lt;\/option&gt;\n&lt;option value=&quot;BY&quot;&gt;Belarus&lt;\/option&gt;\n&lt;option value=&quot;BE&quot;&gt;Belgium&lt;\/option&gt;\n&lt;option value=&quot;BZ&quot;&gt;Belize&lt;\/option&gt;\n&lt;option value=&quot;BJ&quot;&gt;Benin&lt;\/option&gt;\n&lt;option value=&quot;BM&quot;&gt;Bermuda&lt;\/option&gt;\n&lt;option value=&quot;BT&quot;&gt;Bhutan&lt;\/option&gt;\n&lt;option value=&quot;BO&quot;&gt;Bolivia, Plurinational State of&lt;\/option&gt;\n&lt;option value=&quot;BQ&quot;&gt;Bonaire, Sint Eustatius and Saba&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bosnia and Herzegovina&lt;\/option&gt;\n&lt;option value=&quot;BW&quot;&gt;Botswana&lt;\/option&gt;\n&lt;option value=&quot;BV&quot;&gt;Bouvet Island&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Brazil&lt;\/option&gt;\n&lt;option value=&quot;IO&quot;&gt;British Indian Ocean Territory&lt;\/option&gt;\n&lt;option value=&quot;BN&quot;&gt;Brunei Darussalam&lt;\/option&gt;\n&lt;option value=&quot;BG&quot;&gt;Bulgaria&lt;\/option&gt;\n&lt;option value=&quot;BF&quot;&gt;Burkina Faso&lt;\/option&gt;\n&lt;option value=&quot;BI&quot;&gt;Burundi&lt;\/option&gt;\n&lt;option value=&quot;KH&quot;&gt;Cambodia&lt;\/option&gt;\n&lt;option value=&quot;CM&quot;&gt;Cameroon&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;Canada&lt;\/option&gt;\n&lt;option value=&quot;CV&quot;&gt;Cape Verde&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Cayman Islands&lt;\/option&gt;\n&lt;option value=&quot;CF&quot;&gt;Central African Republic&lt;\/option&gt;\n&lt;option value=&quot;TD&quot;&gt;Chad&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Chile&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;China&lt;\/option&gt;\n&lt;option value=&quot;CX&quot;&gt;Christmas Island&lt;\/option&gt;\n&lt;option value=&quot;CC&quot;&gt;Cocos (Keeling) Islands&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Colombia&lt;\/option&gt;\n&lt;option value=&quot;KM&quot;&gt;Comoros&lt;\/option&gt;\n&lt;option value=&quot;CG&quot;&gt;Congo&lt;\/option&gt;\n&lt;option value=&quot;CD&quot;&gt;Congo, the Democratic Republic of the&lt;\/option&gt;\n&lt;option value=&quot;CK&quot;&gt;Cook Islands&lt;\/option&gt;\n&lt;option value=&quot;CR&quot;&gt;Costa Rica&lt;\/option&gt;\n&lt;option value=&quot;CI&quot;&gt;Cote d&amp;#39;Ivoire&lt;\/option&gt;\n&lt;option value=&quot;HR&quot;&gt;Croatia&lt;\/option&gt;\n&lt;option value=&quot;CU&quot;&gt;Cuba&lt;\/option&gt;\n&lt;option value=&quot;CW&quot;&gt;Cura&ccedil;ao&lt;\/option&gt;\n&lt;option value=&quot;CY&quot;&gt;Cyprus&lt;\/option&gt;\n&lt;option value=&quot;CZ&quot;&gt;Czech Republic&lt;\/option&gt;\n&lt;option value=&quot;DK&quot;&gt;Denmark&lt;\/option&gt;\n&lt;option value=&quot;DJ&quot;&gt;Djibouti&lt;\/option&gt;\n&lt;option value=&quot;DM&quot;&gt;Dominica&lt;\/option&gt;\n&lt;option value=&quot;DO&quot;&gt;Dominican Republic&lt;\/option&gt;\n&lt;option value=&quot;EC&quot;&gt;Ecuador&lt;\/option&gt;\n&lt;option value=&quot;EG&quot;&gt;Egypt&lt;\/option&gt;\n&lt;option value=&quot;SV&quot;&gt;El Salvador&lt;\/option&gt;\n&lt;option value=&quot;GQ&quot;&gt;Equatorial Guinea&lt;\/option&gt;\n&lt;option value=&quot;ER&quot;&gt;Eritrea&lt;\/option&gt;\n&lt;option value=&quot;EE&quot;&gt;Estonia&lt;\/option&gt;\n&lt;option value=&quot;ET&quot;&gt;Ethiopia&lt;\/option&gt;\n&lt;option value=&quot;FK&quot;&gt;Falkland Islands (Malvinas)&lt;\/option&gt;\n&lt;option value=&quot;FO&quot;&gt;Faroe Islands&lt;\/option&gt;\n&lt;option value=&quot;FJ&quot;&gt;Fiji&lt;\/option&gt;\n&lt;option value=&quot;FI&quot;&gt;Finland&lt;\/option&gt;\n&lt;option value=&quot;FR&quot;&gt;France&lt;\/option&gt;\n&lt;option value=&quot;GF&quot;&gt;French Guiana&lt;\/option&gt;\n&lt;option value=&quot;PF&quot;&gt;French Polynesia&lt;\/option&gt;\n&lt;option value=&quot;TF&quot;&gt;French Southern Territories&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Gabon&lt;\/option&gt;\n&lt;option value=&quot;GM&quot;&gt;Gambia&lt;\/option&gt;\n&lt;option value=&quot;GE&quot;&gt;Georgia&lt;\/option&gt;\n&lt;option value=&quot;DE&quot;&gt;Germany&lt;\/option&gt;\n&lt;option value=&quot;GH&quot;&gt;Ghana&lt;\/option&gt;\n&lt;option value=&quot;GI&quot;&gt;Gibraltar&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Greece&lt;\/option&gt;\n&lt;option value=&quot;GL&quot;&gt;Greenland&lt;\/option&gt;\n&lt;option value=&quot;GD&quot;&gt;Grenada&lt;\/option&gt;\n&lt;option value=&quot;GP&quot;&gt;Guadeloupe&lt;\/option&gt;\n&lt;option value=&quot;GT&quot;&gt;Guatemala&lt;\/option&gt;\n&lt;option value=&quot;GG&quot;&gt;Guernsey&lt;\/option&gt;\n&lt;option value=&quot;GN&quot;&gt;Guinea&lt;\/option&gt;\n&lt;option value=&quot;GW&quot;&gt;Guinea-Bissau&lt;\/option&gt;\n&lt;option value=&quot;GY&quot;&gt;Guyana&lt;\/option&gt;\n&lt;option value=&quot;HT&quot;&gt;Haiti&lt;\/option&gt;\n&lt;option value=&quot;HM&quot;&gt;Heard Island and McDonald Islands&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Holy See (Vatican City State)&lt;\/option&gt;\n&lt;option value=&quot;HN&quot;&gt;Honduras&lt;\/option&gt;\n&lt;option value=&quot;HU&quot;&gt;Hungary&lt;\/option&gt;\n&lt;option value=&quot;IS&quot;&gt;Iceland&lt;\/option&gt;\n&lt;option value=&quot;IN&quot;&gt;India&lt;\/option&gt;\n&lt;option value=&quot;ID&quot;&gt;Indonesia&lt;\/option&gt;\n&lt;option value=&quot;IR&quot;&gt;Iran, Islamic Republic of&lt;\/option&gt;\n&lt;option value=&quot;IQ&quot;&gt;Iraq&lt;\/option&gt;\n&lt;option value=&quot;IE&quot;&gt;Ireland&lt;\/option&gt;\n&lt;option value=&quot;IM&quot;&gt;Isle of Man&lt;\/option&gt;\n&lt;option value=&quot;IL&quot;&gt;Israel&lt;\/option&gt;\n&lt;option value=&quot;IT&quot;&gt;Italy&lt;\/option&gt;\n&lt;option value=&quot;JM&quot;&gt;Jamaica&lt;\/option&gt;\n&lt;option value=&quot;JP&quot;&gt;Japan&lt;\/option&gt;\n&lt;option value=&quot;JE&quot;&gt;Jersey&lt;\/option&gt;\n&lt;option value=&quot;JO&quot;&gt;Jordan&lt;\/option&gt;\n&lt;option value=&quot;KZ&quot;&gt;Kazakhstan&lt;\/option&gt;\n&lt;option value=&quot;KE&quot;&gt;Kenya&lt;\/option&gt;\n&lt;option value=&quot;KI&quot;&gt;Kiribati&lt;\/option&gt;\n&lt;option value=&quot;KP&quot;&gt;Korea, Democratic People&amp;#39;s Republic of&lt;\/option&gt;\n&lt;option value=&quot;KR&quot;&gt;Korea, Republic of&lt;\/option&gt;\n&lt;option value=&quot;KW&quot;&gt;Kuwait&lt;\/option&gt;\n&lt;option value=&quot;KG&quot;&gt;Kyrgyzstan&lt;\/option&gt;\n&lt;option value=&quot;LA&quot;&gt;Lao People&amp;#39;s Democratic Republic&lt;\/option&gt;\n&lt;option value=&quot;LV&quot;&gt;Latvia&lt;\/option&gt;\n&lt;option value=&quot;LB&quot;&gt;Lebanon&lt;\/option&gt;\n&lt;option value=&quot;LS&quot;&gt;Lesotho&lt;\/option&gt;\n&lt;option value=&quot;LR&quot;&gt;Liberia&lt;\/option&gt;\n&lt;option value=&quot;LY&quot;&gt;Libya&lt;\/option&gt;\n&lt;option value=&quot;LI&quot;&gt;Liechtenstein&lt;\/option&gt;\n&lt;option value=&quot;LT&quot;&gt;Lithuania&lt;\/option&gt;\n&lt;option value=&quot;LU&quot;&gt;Luxembourg&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Macao&lt;\/option&gt;\n&lt;option value=&quot;MK&quot;&gt;Macedonia, the former Yugoslav Republic of&lt;\/option&gt;\n&lt;option value=&quot;MG&quot;&gt;Madagascar&lt;\/option&gt;\n&lt;option value=&quot;MW&quot;&gt;Malawi&lt;\/option&gt;\n&lt;option value=&quot;MY&quot;&gt;Malaysia&lt;\/option&gt;\n&lt;option value=&quot;MV&quot;&gt;Maldives&lt;\/option&gt;\n&lt;option value=&quot;ML&quot;&gt;Mali&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Malta&lt;\/option&gt;\n&lt;option value=&quot;MQ&quot;&gt;Martinique&lt;\/option&gt;\n&lt;option value=&quot;MR&quot;&gt;Mauritania&lt;\/option&gt;\n&lt;option value=&quot;MU&quot;&gt;Mauritius&lt;\/option&gt;\n&lt;option value=&quot;YT&quot;&gt;Mayotte&lt;\/option&gt;\n&lt;option value=&quot;MX&quot;&gt;Mexico&lt;\/option&gt;\n&lt;option value=&quot;MD&quot;&gt;Moldova, Republic of&lt;\/option&gt;\n&lt;option value=&quot;MC&quot;&gt;Monaco&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Mongolia&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Montenegro&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Montserrat&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Morocco&lt;\/option&gt;\n&lt;option value=&quot;MZ&quot;&gt;Mozambique&lt;\/option&gt;\n&lt;option value=&quot;MM&quot;&gt;Myanmar&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Namibia&lt;\/option&gt;\n&lt;option value=&quot;NR&quot;&gt;Nauru&lt;\/option&gt;\n&lt;option value=&quot;NP&quot;&gt;Nepal&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Netherlands&lt;\/option&gt;\n&lt;option value=&quot;NC&quot;&gt;New Caledonia&lt;\/option&gt;\n&lt;option value=&quot;NZ&quot;&gt;New Zealand&lt;\/option&gt;\n&lt;option value=&quot;NI&quot;&gt;Nicaragua&lt;\/option&gt;\n&lt;option value=&quot;NE&quot;&gt;Niger&lt;\/option&gt;\n&lt;option value=&quot;NG&quot;&gt;Nigeria&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Niue&lt;\/option&gt;\n&lt;option value=&quot;NF&quot;&gt;Norfolk Island&lt;\/option&gt;\n&lt;option value=&quot;NO&quot;&gt;Norway&lt;\/option&gt;\n&lt;option value=&quot;OM&quot;&gt;Oman&lt;\/option&gt;\n&lt;option value=&quot;PK&quot;&gt;Pakistan&lt;\/option&gt;\n&lt;option value=&quot;PS&quot;&gt;Palestine&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Panama&lt;\/option&gt;\n&lt;option value=&quot;PG&quot;&gt;Papua New Guinea&lt;\/option&gt;\n&lt;option value=&quot;PY&quot;&gt;Paraguay&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Peru&lt;\/option&gt;\n&lt;option value=&quot;PH&quot;&gt;Philippines&lt;\/option&gt;\n&lt;option value=&quot;PN&quot;&gt;Pitcairn&lt;\/option&gt;\n&lt;option value=&quot;PL&quot;&gt;Poland&lt;\/option&gt;\n&lt;option value=&quot;PT&quot;&gt;Portugal&lt;\/option&gt;\n&lt;option value=&quot;QA&quot;&gt;Qatar&lt;\/option&gt;\n&lt;option value=&quot;RE&quot;&gt;Reunion&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Romania&lt;\/option&gt;\n&lt;option value=&quot;RU&quot;&gt;Russian Federation&lt;\/option&gt;\n&lt;option value=&quot;RW&quot;&gt;Rwanda&lt;\/option&gt;\n&lt;option value=&quot;BL&quot;&gt;Saint Barth&eacute;lemy&lt;\/option&gt;\n&lt;option value=&quot;SH&quot;&gt;Saint Helena, Ascension and Tristan da Cunha&lt;\/option&gt;\n&lt;option value=&quot;KN&quot;&gt;Saint Kitts and Nevis&lt;\/option&gt;\n&lt;option value=&quot;LC&quot;&gt;Saint Lucia&lt;\/option&gt;\n&lt;option value=&quot;MF&quot;&gt;Saint Martin (French part)&lt;\/option&gt;\n&lt;option value=&quot;PM&quot;&gt;Saint Pierre and Miquelon&lt;\/option&gt;\n&lt;option value=&quot;VC&quot;&gt;Saint Vincent and the Grenadines&lt;\/option&gt;\n&lt;option value=&quot;WS&quot;&gt;Samoa&lt;\/option&gt;\n&lt;option value=&quot;SM&quot;&gt;San Marino&lt;\/option&gt;\n&lt;option value=&quot;ST&quot;&gt;Sao Tome and Principe&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;Saudi Arabia&lt;\/option&gt;\n&lt;option value=&quot;SN&quot;&gt;Senegal&lt;\/option&gt;\n&lt;option value=&quot;RS&quot;&gt;Serbia&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;Seychelles&lt;\/option&gt;\n&lt;option value=&quot;SL&quot;&gt;Sierra Leone&lt;\/option&gt;\n&lt;option value=&quot;SG&quot;&gt;Singapore&lt;\/option&gt;\n&lt;option value=&quot;SX&quot;&gt;Sint Maarten (Dutch part)&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Slovakia&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Slovenia&lt;\/option&gt;\n&lt;option value=&quot;SB&quot;&gt;Solomon Islands&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Somalia&lt;\/option&gt;\n&lt;option value=&quot;ZA&quot;&gt;South Africa&lt;\/option&gt;\n&lt;option value=&quot;GS&quot;&gt;South Georgia and the South Sandwich Islands&lt;\/option&gt;\n&lt;option value=&quot;SS&quot;&gt;South Sudan&lt;\/option&gt;\n&lt;option value=&quot;ES&quot;&gt;Spain&lt;\/option&gt;\n&lt;option value=&quot;LK&quot;&gt;Sri Lanka&lt;\/option&gt;\n&lt;option value=&quot;SD&quot;&gt;Sudan&lt;\/option&gt;\n&lt;option value=&quot;SR&quot;&gt;Suriname&lt;\/option&gt;\n&lt;option value=&quot;SJ&quot;&gt;Svalbard and Jan Mayen&lt;\/option&gt;\n&lt;option value=&quot;SZ&quot;&gt;Swaziland&lt;\/option&gt;\n&lt;option value=&quot;SE&quot;&gt;Sweden&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Switzerland&lt;\/option&gt;\n&lt;option value=&quot;SY&quot;&gt;Syrian Arab Republic&lt;\/option&gt;\n&lt;option value=&quot;TW&quot;&gt;Taiwan&lt;\/option&gt;\n&lt;option value=&quot;TJ&quot;&gt;Tajikistan&lt;\/option&gt;\n&lt;option value=&quot;TZ&quot;&gt;Tanzania, United Republic of&lt;\/option&gt;\n&lt;option value=&quot;TH&quot;&gt;Thailand&lt;\/option&gt;\n&lt;option value=&quot;TL&quot;&gt;Timor-Leste&lt;\/option&gt;\n&lt;option value=&quot;TG&quot;&gt;Togo&lt;\/option&gt;\n&lt;option value=&quot;TK&quot;&gt;Tokelau&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Tonga&lt;\/option&gt;\n&lt;option value=&quot;TT&quot;&gt;Trinidad and Tobago&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tunisia&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Turkey&lt;\/option&gt;\n&lt;option value=&quot;TM&quot;&gt;Turkmenistan&lt;\/option&gt;\n&lt;option value=&quot;TC&quot;&gt;Turks and Caicos Islands&lt;\/option&gt;\n&lt;option value=&quot;TV&quot;&gt;Tuvalu&lt;\/option&gt;\n&lt;option value=&quot;UG&quot;&gt;Uganda&lt;\/option&gt;\n&lt;option value=&quot;UA&quot;&gt;Ukraine&lt;\/option&gt;\n&lt;option value=&quot;AE&quot;&gt;United Arab Emirates&lt;\/option&gt;\n&lt;option value=&quot;GB&quot;&gt;United Kingdom&lt;\/option&gt;\n&lt;option value=&quot;US&quot;&gt;United States&lt;\/option&gt;\n&lt;option value=&quot;UY&quot;&gt;Uruguay&lt;\/option&gt;\n&lt;option value=&quot;UZ&quot;&gt;Uzbekistan&lt;\/option&gt;\n&lt;option value=&quot;VU&quot;&gt;Vanuatu&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Venezuela, Bolivarian Republic of&lt;\/option&gt;\n&lt;option value=&quot;VN&quot;&gt;Vietnam&lt;\/option&gt;\n&lt;option value=&quot;VG&quot;&gt;Virgin Islands, British&lt;\/option&gt;\n&lt;option value=&quot;WF&quot;&gt;Wallis and Futuna&lt;\/option&gt;\n&lt;option value=&quot;EH&quot;&gt;Western Sahara&lt;\/option&gt;\n&lt;option value=&quot;YE&quot;&gt;Yemen&lt;\/option&gt;\n&lt;option value=&quot;ZM&quot;&gt;Zambia&lt;\/option&gt;\n&lt;option value=&quot;ZW&quot;&gt;Zimbabwe&lt;\/option&gt;\n&lt;\/select&gt;&lt;br&gt;\n\n&lt;label for=&quot;state_code&quot;&gt;State\/Province&lt;\/label&gt;&lt;select  id=&quot;state_code&quot; name=&quot;state_code&quot;&gt;&lt;option value=&quot;&quot;&gt;--None--&lt;\/option&gt;&lt;option value=&quot;AC&quot;&gt;Acre&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Agrigento&lt;\/option&gt;\n&lt;option value=&quot;AG&quot;&gt;Aguascalientes&lt;\/option&gt;\n&lt;option value=&quot;05&quot;&gt;Aichi&lt;\/option&gt;\n&lt;option value=&quot;02&quot;&gt;Akita&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alabama&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alagoas&lt;\/option&gt;\n&lt;option value=&quot;AK&quot;&gt;Alaska&lt;\/option&gt;\n&lt;option value=&quot;AB&quot;&gt;Alberta&lt;\/option&gt;\n&lt;option value=&quot;AL&quot;&gt;Alessandria&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Amap&aacute;&lt;\/option&gt;\n&lt;option value=&quot;AM&quot;&gt;Amazonas&lt;\/option&gt;\n&lt;option value=&quot;AN&quot;&gt;Ancona&lt;\/option&gt;\n&lt;option value=&quot;AN&quot;&gt;Andaman and Nicobar Islands&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Andhra Pradesh&lt;\/option&gt;\n&lt;option value=&quot;34&quot;&gt;Anhui&lt;\/option&gt;\n&lt;option value=&quot;23&quot;&gt;Aomori&lt;\/option&gt;\n&lt;option value=&quot;AO&quot;&gt;Aosta&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arezzo&lt;\/option&gt;\n&lt;option value=&quot;AZ&quot;&gt;Arizona&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arkansas&lt;\/option&gt;\n&lt;option value=&quot;AR&quot;&gt;Arunachal Pradesh&lt;\/option&gt;\n&lt;option value=&quot;AP&quot;&gt;Ascoli Piceno&lt;\/option&gt;\n&lt;option value=&quot;AS&quot;&gt;Assam&lt;\/option&gt;\n&lt;option value=&quot;AT&quot;&gt;Asti&lt;\/option&gt;\n&lt;option value=&quot;ACT&quot;&gt;Australian Capital Territory&lt;\/option&gt;\n&lt;option value=&quot;AV&quot;&gt;Avellino&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bahia&lt;\/option&gt;\n&lt;option value=&quot;BC&quot;&gt;Baja California&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Baja California Sur&lt;\/option&gt;\n&lt;option value=&quot;BA&quot;&gt;Bari&lt;\/option&gt;\n&lt;option value=&quot;BT&quot;&gt;Barletta-Andria-Trani&lt;\/option&gt;\n&lt;option value=&quot;11&quot;&gt;Beijing&lt;\/option&gt;\n&lt;option value=&quot;BL&quot;&gt;Belluno&lt;\/option&gt;\n&lt;option value=&quot;BN&quot;&gt;Benevento&lt;\/option&gt;\n&lt;option value=&quot;BG&quot;&gt;Bergamo&lt;\/option&gt;\n&lt;option value=&quot;BI&quot;&gt;Biella&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Bihar&lt;\/option&gt;\n&lt;option value=&quot;BO&quot;&gt;Bologna&lt;\/option&gt;\n&lt;option value=&quot;BZ&quot;&gt;Bolzano&lt;\/option&gt;\n&lt;option value=&quot;BS&quot;&gt;Brescia&lt;\/option&gt;\n&lt;option value=&quot;BR&quot;&gt;Brindisi&lt;\/option&gt;\n&lt;option value=&quot;BC&quot;&gt;British Columbia&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;Cagliari&lt;\/option&gt;\n&lt;option value=&quot;CA&quot;&gt;California&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Caltanissetta&lt;\/option&gt;\n&lt;option value=&quot;CM&quot;&gt;Campeche&lt;\/option&gt;\n&lt;option value=&quot;CB&quot;&gt;Campobasso&lt;\/option&gt;\n&lt;option value=&quot;CI&quot;&gt;Carbonia-Iglesias&lt;\/option&gt;\n&lt;option value=&quot;CW&quot;&gt;Carlow&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Caserta&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Catania&lt;\/option&gt;\n&lt;option value=&quot;CZ&quot;&gt;Catanzaro&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;Cavan&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Cear&aacute;&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chandigarh&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Chhattisgarh&lt;\/option&gt;\n&lt;option value=&quot;CS&quot;&gt;Chiapas&lt;\/option&gt;\n&lt;option value=&quot;12&quot;&gt;Chiba&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chieti&lt;\/option&gt;\n&lt;option value=&quot;CH&quot;&gt;Chihuahua&lt;\/option&gt;\n&lt;option value=&quot;50&quot;&gt;Chongqing&lt;\/option&gt;\n&lt;option value=&quot;CE&quot;&gt;Clare&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Coahuila&lt;\/option&gt;\n&lt;option value=&quot;CL&quot;&gt;Colima&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Colorado&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Como&lt;\/option&gt;\n&lt;option value=&quot;CT&quot;&gt;Connecticut&lt;\/option&gt;\n&lt;option value=&quot;CO&quot;&gt;Cork&lt;\/option&gt;\n&lt;option value=&quot;CS&quot;&gt;Cosenza&lt;\/option&gt;\n&lt;option value=&quot;CR&quot;&gt;Cremona&lt;\/option&gt;\n&lt;option value=&quot;KR&quot;&gt;Crotone&lt;\/option&gt;\n&lt;option value=&quot;CN&quot;&gt;Cuneo&lt;\/option&gt;\n&lt;option value=&quot;DN&quot;&gt;Dadra and Nagar Haveli&lt;\/option&gt;\n&lt;option value=&quot;DD&quot;&gt;Daman and Diu&lt;\/option&gt;\n&lt;option value=&quot;DE&quot;&gt;Delaware&lt;\/option&gt;\n&lt;option value=&quot;DL&quot;&gt;Delhi&lt;\/option&gt;\n&lt;option value=&quot;DC&quot;&gt;District of Columbia&lt;\/option&gt;\n&lt;option value=&quot;DF&quot;&gt;Distrito Federal&lt;\/option&gt;\n&lt;option value=&quot;DL&quot;&gt;Donegal&lt;\/option&gt;\n&lt;option value=&quot;D&quot;&gt;Dublin&lt;\/option&gt;\n&lt;option value=&quot;DG&quot;&gt;Durango&lt;\/option&gt;\n&lt;option value=&quot;38&quot;&gt;Ehime&lt;\/option&gt;\n&lt;option value=&quot;EN&quot;&gt;Enna&lt;\/option&gt;\n&lt;option value=&quot;ES&quot;&gt;Esp&iacute;rito Santo&lt;\/option&gt;\n&lt;option value=&quot;DF&quot;&gt;Federal District&lt;\/option&gt;\n&lt;option value=&quot;FM&quot;&gt;Fermo&lt;\/option&gt;\n&lt;option value=&quot;FE&quot;&gt;Ferrara&lt;\/option&gt;\n&lt;option value=&quot;FI&quot;&gt;Florence&lt;\/option&gt;\n&lt;option value=&quot;FL&quot;&gt;Florida&lt;\/option&gt;\n&lt;option value=&quot;FG&quot;&gt;Foggia&lt;\/option&gt;\n&lt;option value=&quot;FC&quot;&gt;Forl&igrave;-Cesena&lt;\/option&gt;\n&lt;option value=&quot;FR&quot;&gt;Frosinone&lt;\/option&gt;\n&lt;option value=&quot;35&quot;&gt;Fujian&lt;\/option&gt;\n&lt;option value=&quot;18&quot;&gt;Fukui&lt;\/option&gt;\n&lt;option value=&quot;40&quot;&gt;Fukuoka&lt;\/option&gt;\n&lt;option value=&quot;07&quot;&gt;Fukushima&lt;\/option&gt;\n&lt;option value=&quot;G&quot;&gt;Galway&lt;\/option&gt;\n&lt;option value=&quot;62&quot;&gt;Gansu&lt;\/option&gt;\n&lt;option value=&quot;GE&quot;&gt;Genoa&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Georgia&lt;\/option&gt;\n&lt;option value=&quot;21&quot;&gt;Gifu&lt;\/option&gt;\n&lt;option value=&quot;GA&quot;&gt;Goa&lt;\/option&gt;\n&lt;option value=&quot;GO&quot;&gt;Goi&aacute;s&lt;\/option&gt;\n&lt;option value=&quot;GO&quot;&gt;Gorizia&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Grosseto&lt;\/option&gt;\n&lt;option value=&quot;GT&quot;&gt;Guanajuato&lt;\/option&gt;\n&lt;option value=&quot;44&quot;&gt;Guangdong&lt;\/option&gt;\n&lt;option value=&quot;45&quot;&gt;Guangxi&lt;\/option&gt;\n&lt;option value=&quot;GR&quot;&gt;Guerrero&lt;\/option&gt;\n&lt;option value=&quot;52&quot;&gt;Guizhou&lt;\/option&gt;\n&lt;option value=&quot;GJ&quot;&gt;Gujarat&lt;\/option&gt;\n&lt;option value=&quot;10&quot;&gt;Gunma&lt;\/option&gt;\n&lt;option value=&quot;46&quot;&gt;Hainan&lt;\/option&gt;\n&lt;option value=&quot;HR&quot;&gt;Haryana&lt;\/option&gt;\n&lt;option value=&quot;HI&quot;&gt;Hawaii&lt;\/option&gt;\n&lt;option value=&quot;13&quot;&gt;Hebei&lt;\/option&gt;\n&lt;option value=&quot;23&quot;&gt;Heilongjiang&lt;\/option&gt;\n&lt;option value=&quot;41&quot;&gt;Henan&lt;\/option&gt;\n&lt;option value=&quot;HG&quot;&gt;Hidalgo&lt;\/option&gt;\n&lt;option value=&quot;HP&quot;&gt;Himachal Pradesh&lt;\/option&gt;\n&lt;option value=&quot;34&quot;&gt;Hiroshima&lt;\/option&gt;\n&lt;option value=&quot;01&quot;&gt;Hokkaido&lt;\/option&gt;\n&lt;option value=&quot;91&quot;&gt;Hong Kong&lt;\/option&gt;\n&lt;option value=&quot;42&quot;&gt;Hubei&lt;\/option&gt;\n&lt;option value=&quot;43&quot;&gt;Hunan&lt;\/option&gt;\n&lt;option value=&quot;28&quot;&gt;Hyogo&lt;\/option&gt;\n&lt;option value=&quot;08&quot;&gt;Ibaraki&lt;\/option&gt;\n&lt;option value=&quot;ID&quot;&gt;Idaho&lt;\/option&gt;\n&lt;option value=&quot;IL&quot;&gt;Illinois&lt;\/option&gt;\n&lt;option value=&quot;IM&quot;&gt;Imperia&lt;\/option&gt;\n&lt;option value=&quot;IN&quot;&gt;Indiana&lt;\/option&gt;\n&lt;option value=&quot;IA&quot;&gt;Iowa&lt;\/option&gt;\n&lt;option value=&quot;IS&quot;&gt;Isernia&lt;\/option&gt;\n&lt;option value=&quot;17&quot;&gt;Ishikawa&lt;\/option&gt;\n&lt;option value=&quot;03&quot;&gt;Iwate&lt;\/option&gt;\n&lt;option value=&quot;JA&quot;&gt;Jalisco&lt;\/option&gt;\n&lt;option value=&quot;JK&quot;&gt;Jammu and Kashmir&lt;\/option&gt;\n&lt;option value=&quot;JH&quot;&gt;Jharkhand&lt;\/option&gt;\n&lt;option value=&quot;32&quot;&gt;Jiangsu&lt;\/option&gt;\n&lt;option value=&quot;36&quot;&gt;Jiangxi&lt;\/option&gt;\n&lt;option value=&quot;22&quot;&gt;Jilin&lt;\/option&gt;\n&lt;option value=&quot;37&quot;&gt;Kagawa&lt;\/option&gt;\n&lt;option value=&quot;46&quot;&gt;Kagoshima&lt;\/option&gt;\n&lt;option value=&quot;14&quot;&gt;Kanagawa&lt;\/option&gt;\n&lt;option value=&quot;KS&quot;&gt;Kansas&lt;\/option&gt;\n&lt;option value=&quot;KA&quot;&gt;Karnataka&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Kentucky&lt;\/option&gt;\n&lt;option value=&quot;KL&quot;&gt;Kerala&lt;\/option&gt;\n&lt;option value=&quot;KY&quot;&gt;Kerry&lt;\/option&gt;\n&lt;option value=&quot;KE&quot;&gt;Kildare&lt;\/option&gt;\n&lt;option value=&quot;KK&quot;&gt;Kilkenny&lt;\/option&gt;\n&lt;option value=&quot;39&quot;&gt;Kochi&lt;\/option&gt;\n&lt;option value=&quot;43&quot;&gt;Kumamoto&lt;\/option&gt;\n&lt;option value=&quot;26&quot;&gt;Kyoto&lt;\/option&gt;\n&lt;option value=&quot;AQ&quot;&gt;L&amp;#39;Aquila&lt;\/option&gt;\n&lt;option value=&quot;LD&quot;&gt;Lakshadweep&lt;\/option&gt;\n&lt;option value=&quot;LS&quot;&gt;Laois&lt;\/option&gt;\n&lt;option value=&quot;SP&quot;&gt;La Spezia&lt;\/option&gt;\n&lt;option value=&quot;LT&quot;&gt;Latina&lt;\/option&gt;\n&lt;option value=&quot;LE&quot;&gt;Lecce&lt;\/option&gt;\n&lt;option value=&quot;LC&quot;&gt;Lecco&lt;\/option&gt;\n&lt;option value=&quot;LM&quot;&gt;Leitrim&lt;\/option&gt;\n&lt;option value=&quot;21&quot;&gt;Liaoning&lt;\/option&gt;\n&lt;option value=&quot;LK&quot;&gt;Limerick&lt;\/option&gt;\n&lt;option value=&quot;LI&quot;&gt;Livorno&lt;\/option&gt;\n&lt;option value=&quot;LO&quot;&gt;Lodi&lt;\/option&gt;\n&lt;option value=&quot;LD&quot;&gt;Longford&lt;\/option&gt;\n&lt;option value=&quot;LA&quot;&gt;Louisiana&lt;\/option&gt;\n&lt;option value=&quot;LH&quot;&gt;Louth&lt;\/option&gt;\n&lt;option value=&quot;LU&quot;&gt;Lucca&lt;\/option&gt;\n&lt;option value=&quot;92&quot;&gt;Macao&lt;\/option&gt;\n&lt;option value=&quot;MC&quot;&gt;Macerata&lt;\/option&gt;\n&lt;option value=&quot;MP&quot;&gt;Madhya Pradesh&lt;\/option&gt;\n&lt;option value=&quot;MH&quot;&gt;Maharashtra&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Maine&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Manipur&lt;\/option&gt;\n&lt;option value=&quot;MB&quot;&gt;Manitoba&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Mantua&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Maranh&atilde;o&lt;\/option&gt;\n&lt;option value=&quot;MD&quot;&gt;Maryland&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Massa and Carrara&lt;\/option&gt;\n&lt;option value=&quot;MA&quot;&gt;Massachusetts&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Matera&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Mato Grosso&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Mato Grosso do Sul&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Mayo&lt;\/option&gt;\n&lt;option value=&quot;MH&quot;&gt;Meath&lt;\/option&gt;\n&lt;option value=&quot;VS&quot;&gt;Medio Campidano&lt;\/option&gt;\n&lt;option value=&quot;ML&quot;&gt;Meghalaya&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Messina&lt;\/option&gt;\n&lt;option value=&quot;ME&quot;&gt;Mexico State&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Michigan&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Michoac&aacute;n&lt;\/option&gt;\n&lt;option value=&quot;24&quot;&gt;Mie&lt;\/option&gt;\n&lt;option value=&quot;MI&quot;&gt;Milan&lt;\/option&gt;\n&lt;option value=&quot;MG&quot;&gt;Minas Gerais&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Minnesota&lt;\/option&gt;\n&lt;option value=&quot;MS&quot;&gt;Mississippi&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Missouri&lt;\/option&gt;\n&lt;option value=&quot;04&quot;&gt;Miyagi&lt;\/option&gt;\n&lt;option value=&quot;45&quot;&gt;Miyazaki&lt;\/option&gt;\n&lt;option value=&quot;MZ&quot;&gt;Mizoram&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Modena&lt;\/option&gt;\n&lt;option value=&quot;MN&quot;&gt;Monaghan&lt;\/option&gt;\n&lt;option value=&quot;MT&quot;&gt;Montana&lt;\/option&gt;\n&lt;option value=&quot;MB&quot;&gt;Monza and Brianza&lt;\/option&gt;\n&lt;option value=&quot;MO&quot;&gt;Morelos&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Nagaland&lt;\/option&gt;\n&lt;option value=&quot;20&quot;&gt;Nagano&lt;\/option&gt;\n&lt;option value=&quot;42&quot;&gt;Nagasaki&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Naples&lt;\/option&gt;\n&lt;option value=&quot;29&quot;&gt;Nara&lt;\/option&gt;\n&lt;option value=&quot;NA&quot;&gt;Nayarit&lt;\/option&gt;\n&lt;option value=&quot;NE&quot;&gt;Nebraska&lt;\/option&gt;\n&lt;option value=&quot;15&quot;&gt;Nei Mongol&lt;\/option&gt;\n&lt;option value=&quot;NV&quot;&gt;Nevada&lt;\/option&gt;\n&lt;option value=&quot;NB&quot;&gt;New Brunswick&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Newfoundland and Labrador&lt;\/option&gt;\n&lt;option value=&quot;NH&quot;&gt;New Hampshire&lt;\/option&gt;\n&lt;option value=&quot;NJ&quot;&gt;New Jersey&lt;\/option&gt;\n&lt;option value=&quot;NM&quot;&gt;New Mexico&lt;\/option&gt;\n&lt;option value=&quot;NSW&quot;&gt;New South Wales&lt;\/option&gt;\n&lt;option value=&quot;NY&quot;&gt;New York&lt;\/option&gt;\n&lt;option value=&quot;15&quot;&gt;Niigata&lt;\/option&gt;\n&lt;option value=&quot;64&quot;&gt;Ningxia&lt;\/option&gt;\n&lt;option value=&quot;NC&quot;&gt;North Carolina&lt;\/option&gt;\n&lt;option value=&quot;ND&quot;&gt;North Dakota&lt;\/option&gt;\n&lt;option value=&quot;NT&quot;&gt;Northern Territory&lt;\/option&gt;\n&lt;option value=&quot;NT&quot;&gt;Northwest Territories&lt;\/option&gt;\n&lt;option value=&quot;NO&quot;&gt;Novara&lt;\/option&gt;\n&lt;option value=&quot;NS&quot;&gt;Nova Scotia&lt;\/option&gt;\n&lt;option value=&quot;NL&quot;&gt;Nuevo Le&oacute;n&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Nunavut&lt;\/option&gt;\n&lt;option value=&quot;NU&quot;&gt;Nuoro&lt;\/option&gt;\n&lt;option value=&quot;OA&quot;&gt;Oaxaca&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Odisha&lt;\/option&gt;\n&lt;option value=&quot;OY&quot;&gt;Offaly&lt;\/option&gt;\n&lt;option value=&quot;OG&quot;&gt;Ogliastra&lt;\/option&gt;\n&lt;option value=&quot;OH&quot;&gt;Ohio&lt;\/option&gt;\n&lt;option value=&quot;44&quot;&gt;Oita&lt;\/option&gt;\n&lt;option value=&quot;33&quot;&gt;Okayama&lt;\/option&gt;\n&lt;option value=&quot;47&quot;&gt;Okinawa&lt;\/option&gt;\n&lt;option value=&quot;OK&quot;&gt;Oklahoma&lt;\/option&gt;\n&lt;option value=&quot;OT&quot;&gt;Olbia-Tempio&lt;\/option&gt;\n&lt;option value=&quot;ON&quot;&gt;Ontario&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Oregon&lt;\/option&gt;\n&lt;option value=&quot;OR&quot;&gt;Oristano&lt;\/option&gt;\n&lt;option value=&quot;27&quot;&gt;Osaka&lt;\/option&gt;\n&lt;option value=&quot;PD&quot;&gt;Padua&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Palermo&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Par&aacute;&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Para&iacute;ba&lt;\/option&gt;\n&lt;option value=&quot;PR&quot;&gt;Paran&aacute;&lt;\/option&gt;\n&lt;option value=&quot;PR&quot;&gt;Parma&lt;\/option&gt;\n&lt;option value=&quot;PV&quot;&gt;Pavia&lt;\/option&gt;\n&lt;option value=&quot;PA&quot;&gt;Pennsylvania&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Pernambuco&lt;\/option&gt;\n&lt;option value=&quot;PG&quot;&gt;Perugia&lt;\/option&gt;\n&lt;option value=&quot;PU&quot;&gt;Pesaro and Urbino&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Pescara&lt;\/option&gt;\n&lt;option value=&quot;PC&quot;&gt;Piacenza&lt;\/option&gt;\n&lt;option value=&quot;PI&quot;&gt;Piau&iacute;&lt;\/option&gt;\n&lt;option value=&quot;PI&quot;&gt;Pisa&lt;\/option&gt;\n&lt;option value=&quot;PT&quot;&gt;Pistoia&lt;\/option&gt;\n&lt;option value=&quot;PN&quot;&gt;Pordenone&lt;\/option&gt;\n&lt;option value=&quot;PZ&quot;&gt;Potenza&lt;\/option&gt;\n&lt;option value=&quot;PO&quot;&gt;Prato&lt;\/option&gt;\n&lt;option value=&quot;PE&quot;&gt;Prince Edward Island&lt;\/option&gt;\n&lt;option value=&quot;PY&quot;&gt;Puducherry&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Puebla&lt;\/option&gt;\n&lt;option value=&quot;PB&quot;&gt;Punjab&lt;\/option&gt;\n&lt;option value=&quot;63&quot;&gt;Qinghai&lt;\/option&gt;\n&lt;option value=&quot;QC&quot;&gt;Quebec&lt;\/option&gt;\n&lt;option value=&quot;QLD&quot;&gt;Queensland&lt;\/option&gt;\n&lt;option value=&quot;QE&quot;&gt;Quer&eacute;taro&lt;\/option&gt;\n&lt;option value=&quot;QR&quot;&gt;Quintana Roo&lt;\/option&gt;\n&lt;option value=&quot;RG&quot;&gt;Ragusa&lt;\/option&gt;\n&lt;option value=&quot;RJ&quot;&gt;Rajasthan&lt;\/option&gt;\n&lt;option value=&quot;RA&quot;&gt;Ravenna&lt;\/option&gt;\n&lt;option value=&quot;RC&quot;&gt;Reggio Calabria&lt;\/option&gt;\n&lt;option value=&quot;RE&quot;&gt;Reggio Emilia&lt;\/option&gt;\n&lt;option value=&quot;RI&quot;&gt;Rhode Island&lt;\/option&gt;\n&lt;option value=&quot;RI&quot;&gt;Rieti&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Rimini&lt;\/option&gt;\n&lt;option value=&quot;RJ&quot;&gt;Rio de Janeiro&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Rio Grande do Norte&lt;\/option&gt;\n&lt;option value=&quot;RS&quot;&gt;Rio Grande do Sul&lt;\/option&gt;\n&lt;option value=&quot;RM&quot;&gt;Rome&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Rond&ocirc;nia&lt;\/option&gt;\n&lt;option value=&quot;RR&quot;&gt;Roraima&lt;\/option&gt;\n&lt;option value=&quot;RN&quot;&gt;Roscommon&lt;\/option&gt;\n&lt;option value=&quot;RO&quot;&gt;Rovigo&lt;\/option&gt;\n&lt;option value=&quot;41&quot;&gt;Saga&lt;\/option&gt;\n&lt;option value=&quot;11&quot;&gt;Saitama&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;Salerno&lt;\/option&gt;\n&lt;option value=&quot;SL&quot;&gt;San Luis Potos&iacute;&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;Santa Catarina&lt;\/option&gt;\n&lt;option value=&quot;SP&quot;&gt;S&atilde;o Paulo&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Saskatchewan&lt;\/option&gt;\n&lt;option value=&quot;SS&quot;&gt;Sassari&lt;\/option&gt;\n&lt;option value=&quot;SV&quot;&gt;Savona&lt;\/option&gt;\n&lt;option value=&quot;SE&quot;&gt;Sergipe&lt;\/option&gt;\n&lt;option value=&quot;61&quot;&gt;Shaanxi&lt;\/option&gt;\n&lt;option value=&quot;37&quot;&gt;Shandong&lt;\/option&gt;\n&lt;option value=&quot;31&quot;&gt;Shanghai&lt;\/option&gt;\n&lt;option value=&quot;14&quot;&gt;Shanxi&lt;\/option&gt;\n&lt;option value=&quot;25&quot;&gt;Shiga&lt;\/option&gt;\n&lt;option value=&quot;32&quot;&gt;Shimane&lt;\/option&gt;\n&lt;option value=&quot;22&quot;&gt;Shizuoka&lt;\/option&gt;\n&lt;option value=&quot;51&quot;&gt;Sichuan&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Siena&lt;\/option&gt;\n&lt;option value=&quot;SK&quot;&gt;Sikkim&lt;\/option&gt;\n&lt;option value=&quot;SI&quot;&gt;Sinaloa&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sligo&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sondrio&lt;\/option&gt;\n&lt;option value=&quot;SO&quot;&gt;Sonora&lt;\/option&gt;\n&lt;option value=&quot;SA&quot;&gt;South Australia&lt;\/option&gt;\n&lt;option value=&quot;SC&quot;&gt;South Carolina&lt;\/option&gt;\n&lt;option value=&quot;SD&quot;&gt;South Dakota&lt;\/option&gt;\n&lt;option value=&quot;SR&quot;&gt;Syracuse&lt;\/option&gt;\n&lt;option value=&quot;TB&quot;&gt;Tabasco&lt;\/option&gt;\n&lt;option value=&quot;71&quot;&gt;Taiwan&lt;\/option&gt;\n&lt;option value=&quot;TM&quot;&gt;Tamaulipas&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tamil Nadu&lt;\/option&gt;\n&lt;option value=&quot;TA&quot;&gt;Taranto&lt;\/option&gt;\n&lt;option value=&quot;TAS&quot;&gt;Tasmania&lt;\/option&gt;\n&lt;option value=&quot;TG&quot;&gt;Telangana&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Tennessee&lt;\/option&gt;\n&lt;option value=&quot;TE&quot;&gt;Teramo&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Terni&lt;\/option&gt;\n&lt;option value=&quot;TX&quot;&gt;Texas&lt;\/option&gt;\n&lt;option value=&quot;12&quot;&gt;Tianjin&lt;\/option&gt;\n&lt;option value=&quot;TA&quot;&gt;Tipperary&lt;\/option&gt;\n&lt;option value=&quot;TL&quot;&gt;Tlaxcala&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Tocantins&lt;\/option&gt;\n&lt;option value=&quot;09&quot;&gt;Tochigi&lt;\/option&gt;\n&lt;option value=&quot;36&quot;&gt;Tokushima&lt;\/option&gt;\n&lt;option value=&quot;13&quot;&gt;Tokyo&lt;\/option&gt;\n&lt;option value=&quot;31&quot;&gt;Tottori&lt;\/option&gt;\n&lt;option value=&quot;16&quot;&gt;Toyama&lt;\/option&gt;\n&lt;option value=&quot;TP&quot;&gt;Trapani&lt;\/option&gt;\n&lt;option value=&quot;TN&quot;&gt;Trento&lt;\/option&gt;\n&lt;option value=&quot;TV&quot;&gt;Treviso&lt;\/option&gt;\n&lt;option value=&quot;TS&quot;&gt;Trieste&lt;\/option&gt;\n&lt;option value=&quot;TR&quot;&gt;Tripura&lt;\/option&gt;\n&lt;option value=&quot;TO&quot;&gt;Turin&lt;\/option&gt;\n&lt;option value=&quot;UD&quot;&gt;Udine&lt;\/option&gt;\n&lt;option value=&quot;UT&quot;&gt;Utah&lt;\/option&gt;\n&lt;option value=&quot;UT&quot;&gt;Uttarakhand&lt;\/option&gt;\n&lt;option value=&quot;UP&quot;&gt;Uttar Pradesh&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Varese&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Venice&lt;\/option&gt;\n&lt;option value=&quot;VE&quot;&gt;Veracruz&lt;\/option&gt;\n&lt;option value=&quot;VB&quot;&gt;Verbano-Cusio-Ossola&lt;\/option&gt;\n&lt;option value=&quot;VC&quot;&gt;Vercelli&lt;\/option&gt;\n&lt;option value=&quot;VT&quot;&gt;Vermont&lt;\/option&gt;\n&lt;option value=&quot;VR&quot;&gt;Verona&lt;\/option&gt;\n&lt;option value=&quot;VV&quot;&gt;Vibo Valentia&lt;\/option&gt;\n&lt;option value=&quot;VI&quot;&gt;Vicenza&lt;\/option&gt;\n&lt;option value=&quot;VIC&quot;&gt;Victoria&lt;\/option&gt;\n&lt;option value=&quot;VA&quot;&gt;Virginia&lt;\/option&gt;\n&lt;option value=&quot;VT&quot;&gt;Viterbo&lt;\/option&gt;\n&lt;option value=&quot;30&quot;&gt;Wakayama&lt;\/option&gt;\n&lt;option value=&quot;WA&quot;&gt;Washington&lt;\/option&gt;\n&lt;option value=&quot;WD&quot;&gt;Waterford&lt;\/option&gt;\n&lt;option value=&quot;WB&quot;&gt;West Bengal&lt;\/option&gt;\n&lt;option value=&quot;WA&quot;&gt;Western Australia&lt;\/option&gt;\n&lt;option value=&quot;WH&quot;&gt;Westmeath&lt;\/option&gt;\n&lt;option value=&quot;WV&quot;&gt;West Virginia&lt;\/option&gt;\n&lt;option value=&quot;WX&quot;&gt;Wexford&lt;\/option&gt;\n&lt;option value=&quot;WW&quot;&gt;Wicklow&lt;\/option&gt;\n&lt;option value=&quot;WI&quot;&gt;Wisconsin&lt;\/option&gt;\n&lt;option value=&quot;WY&quot;&gt;Wyoming&lt;\/option&gt;\n&lt;option value=&quot;65&quot;&gt;Xinjiang&lt;\/option&gt;\n&lt;option value=&quot;54&quot;&gt;Xizang&lt;\/option&gt;\n&lt;option value=&quot;06&quot;&gt;Yamagata&lt;\/option&gt;\n&lt;option value=&quot;35&quot;&gt;Yamaguchi&lt;\/option&gt;\n&lt;option value=&quot;19&quot;&gt;Yamanashi&lt;\/option&gt;\n&lt;option value=&quot;YU&quot;&gt;Yucat&aacute;n&lt;\/option&gt;\n&lt;option value=&quot;YT&quot;&gt;Yukon Territories&lt;\/option&gt;\n&lt;option value=&quot;53&quot;&gt;Yunnan&lt;\/option&gt;\n&lt;option value=&quot;ZA&quot;&gt;Zacatecas&lt;\/option&gt;\n&lt;option 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