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Country	Select OneAfghanistanAlbaniaAlgeriaAngolaAnguillaAntiguaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChannel IslandsChileChinaColombiaCongoCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDominicaDominican RepublicEcuadorEgyptEl SalvadorEnglandEquatorial GuineaEstoniaEthiopiaFalkland IslandsFijiFinlandFranceGabonGeorgiaGermanyGhanaGibraltarGrand BahamaGrand CaymanGreeceGreenlandGrenadaGuatemalaGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKorea, Republic ofKumasiKuwaitKuwaitKyrgyzstanLa MartiniqueLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaliMaltaMariana IslandsMauritiusMexicoMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNegara Brunel DarussalamNepalNetherlandsNetherlands AntillesNew GuineaNew ZealandNicaraguaNigeriaNiueNorthern IrelandNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaudi ArabiaScotlandSenegalSerbiaSierra LeoneSingaporeSlovak RepublicSlovakiaSloveniaSolomon IslandsSouth AfricaSouth KoreaSpainSri LankaSt. KittsSt. LuciaSt. VincentSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTanzaniaThailandTogoTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVenezuelaVietnamWalesYemenYugoslaviaZaireZambiaZimbabwe
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*Country	Select OneAfghanistanAlbaniaAlgeriaAngolaAnguillaAntiguaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChannel IslandsChileChinaColombiaCongoCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDominicaDominican RepublicEcuadorEgyptEl SalvadorEnglandEquatorial GuineaEstoniaEthiopiaFalkland IslandsFijiFinlandFranceGabonGeorgiaGermanyGhanaGibraltarGrand BahamaGrand CaymanGreeceGreenlandGrenadaGuatemalaGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKorea, Republic ofKumasiKuwaitKuwaitKyrgyzstanLa MartiniqueLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaliMaltaMariana IslandsMauritiusMexicoMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNegara Brunel DarussalamNepalNetherlandsNetherlands AntillesNew GuineaNew ZealandNicaraguaNigeriaNiueNorthern IrelandNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaudi ArabiaScotlandSenegalSerbiaSierra LeoneSingaporeSlovak RepublicSlovakiaSloveniaSolomon IslandsSouth AfricaSouth KoreaSpainSri LankaSt. KittsSt. LuciaSt. VincentSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTanzaniaThailandTogoTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVenezuelaVietnamWalesYemenYugoslaviaZaireZambiaZimbabwe
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WJTA Scholarship Fund Donation
WJTA Scholarship Fund Donation	$
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* Name	Name as it appears on the credit card
Type	VisaMasterCardAmerican ExpressDiscover
* Number	Credit Card Number
* Card Verification Code	Three digit number located on back (Visa, MasterCard, Discover) or four digits located on the front of Amex.
* Exp. Date	mm/yyyy
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