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2) Personal Information

First Name:
Last Name:
Postal Code:
Country:	[select country] Afghanistan Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Bavaria Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocoa (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote Divoire Croatia (local name: Hrvatska) Cuba Cyprus Czech Republic Darussalam Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic Peoples Republic of Korea, Republic of Kuwait Kyrgyzstan Lao Peoples Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia $ South Sandwich Islands Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Ulster United Arab Emirates United Kingdom United States Minor Outlying Islands United States of America Unknown Country Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wales Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
Industry:	[select industry] Accounting/Finance Computer (Internet) Computer (IS, MIS, DP) Computer (Software) Consulting Education/Training Engineering Entertainment/Media/Publish Government/Military Legal Services Manufacturing Medical Services Non-Profit Organizations Other Industry Research Sales/Marketing Industry
Education:	[select education] College Graduate Grade School High School Post Graduate Some College Vocational/Technical School
Age:	[select age] 13 to 17 18 to 25 26 to 29 30 to 39 40 to 49 50 to 59 60 and over
Gender:	[select gender] Female Male

3) Interests

Entertainment	Shopping
Business	Religion
Sports & Recreation	Music
Automotive	Computer Hardware
Computer Software	Internet
Free Stuff	Careers
Small Office/Home Office	Personal Finance
Electronics	Games
Health	Computer Peripherals