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value="89">Guadaloupe</option> <option value="90">Guam</option> <option value="91">Guatemala</option> <option value="92">Guernsey</option> <option value="93">Guinea</option> <option value="94">Guinea-Bissau</option> <option value="95">Guyana</option> <option value="96">Haiti</option> <option value="97">Heard Island and McDonald Islands</option> <option value="98">Honduras</option> <option value="99">Hong Kong</option> <option value="100">Hungary</option> <option value="101">Iceland</option> <option value="102">India</option> <option value="103">Indonesia</option> <option value="104">Iran</option> <option value="105">Iraq</option> <option value="106">Ireland</option> <option value="107">Isle of Man</option> <option value="108">Israel</option> <option value="109">Italy</option> <option value="110">Jamaica</option> <option value="111">Japan</option> <option value="112">Jersey</option> <option value="113">Jordan</option> <option value="114">Kazakhstan</option> <option value="115">Kenya</option> <option value="116">Kiribati</option> <option value="117">Kosovo</option> <option value="118">Kuwait</option> <option value="119">Kyrgyzstan</option> <option value="120">Laos</option> <option value="121">Latvia</option> <option value="122">Lebanon</option> <option value="123">Lesotho</option> <option value="124">Liberia</option> <option value="125">Libya</option> <option value="126">Liechtenstein</option> <option value="127">Lithuania</option> <option value="128">Luxembourg</option> <option value="129">Macao</option> <option value="130">Macedonia</option> <option value="131">Madagascar</option> <option value="132">Malawi</option> <option value="133">Malaysia</option> <option value="134">Maldives</option> <option value="135">Mali</option> <option value="136">Malta</option> <option value="137">Marshall Islands</option> <option value="138">Martinique</option> <option value="139">Mauritania</option> <option value="140">Mauritius</option> <option value="141">Mayotte</option> <option value="142">Mexico</option> <option value="143">Micronesia</option> <option value="144">Moldava</option> <option value="145">Monaco</option> <option value="146">Mongolia</option> <option value="147">Montenegro</option> <option value="148">Montserrat</option> <option value="149">Morocco</option> <option value="150">Mozambique</option> <option value="151">Myanmar (Burma)</option> <option value="152">Namibia</option> <option value="153">Nauru</option> <option value="154">Nepal</option> <option value="155">Netherlands</option> <option value="156">New Caledonia</option> <option value="157">New Zealand</option> <option value="158">Nicaragua</option> <option value="159">Niger</option> <option value="160">Nigeria</option> <option value="161">Niue</option> <option value="162">Norfolk Island</option> <option value="163">North Korea</option> <option value="164">Northern Mariana Islands</option> <option value="165">Norway</option> <option value="166">Oman</option> <option value="167">Pakistan</option> <option value="168">Palau</option> <option value="169">Palestine</option> <option value="170">Panama</option> <option value="171">Papua New Guinea</option> <option value="172">Paraguay</option> <option value="173">Peru</option> <option value="174">Phillipines</option> <option value="175">Pitcairn</option> <option value="176">Poland</option> <option value="177">Portugal</option> <option value="178">Puerto Rico</option> <option value="179">Qatar</option> <option value="180">Reunion</option> <option value="181">Romania</option> <option value="182">Russia</option> <option value="183">Rwanda</option> <option value="184">Saint Barthelemy</option> <option value="185">Saint Helena</option> <option value="186">Saint Kitts and Nevis</option> <option value="187">Saint Lucia</option> <option value="188">Saint Martin</option> <option value="189">Saint Pierre and Miquelon</option> <option value="190">Saint Vincent and the 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value="214">Swaziland</option> <option value="215">Sweden</option> <option value="216">Switzerland</option> <option value="217">Syria</option> <option value="218">Taiwan</option> <option value="219">Tajikistan</option> <option value="220">Tanzania</option> <option value="221">Thailand</option> <option value="222">Timor-Leste (East Timor)</option> <option value="223">Togo</option> <option value="224">Tokelau</option> <option value="225">Tonga</option> <option value="226">Trinidad and Tobago</option> <option value="227">Tunisia</option> <option value="228">Turkey</option> <option value="229">Turkmenistan</option> <option value="230">Turks and Caicos Islands</option> <option value="231">Tuvalu</option> <option value="232">Uganda</option> <option value="233">Ukraine</option> <option value="234">United Arab Emirates</option> <option value="235">United Kingdom</option> <option value="236">United States</option> <option value="237">United States Minor Outlying Islands</option> <option value="238">Uruguay</option> <option value="239">Uzbekistan</option> <option value="240">Vanuatu</option> <option value="241">Vatican City</option> <option value="242">Venezuela</option> <option value="243">Vietnam</option> <option value="244">Virgin Islands, British</option> <option value="245">Virgin Islands, US</option> <option value="246">Wallis and Futuna</option> <option value="247">Western Sahara</option> <option value="248">Yemen</option> <option value="249">Zambia</option> <option value="250">Zimbabwe</option> </select></p> <p><label>Institution* :</label><input type="text" name="institution" class="required"></p> <p><label>Department* :</label><input type="text" name="department" class="required"></p> <p><label>Phone* :</label><input maxlength="12" type="text" name="phone" class="required digits" value=""></p> <p><label>Fax:</label><input maxlength="12" type="text" name="fax" class="digits"></p> <p><label>Committee* :</label> <select class="required" name="committee"> <option 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