SIGN UP AND START EARNING POINTS *First Name *Last Name *Email *Mobile Phone ( ) – *Birthday Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910 *Address Street 1 *Address City *Address State Any StateAKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVIVTWAWIWVWY *Address Country — Select One —AlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanAzoresBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCayman IslandsCentral African RepublicChadChannel IslandsChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Democratic Republic of)Cook IslandsCosta RicaCote D’Ivoire (Ivory Coast)CroatiaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaeroe IslandsFalkland Islands (Malvinas)FijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKosraeKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNeutral ZoneNew CaledoniaNew Zealand (Aotearoa)NicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern IrelandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPonapePortugalPuerto RicoQatarReunionRomaniaRotaRussian FederationRwandaSabaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaipanSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaScotlandSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak RepublicSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South Sandwich IslandsSouth KoreaSpainSri LankaSt. BarthelemySt. ChristopherSt. CroixSt. EustatiusSt. HelenaSt. JohnSt. Kitts and NevisSt. LuciaSt. MaartenSt. MartinSt. Pierre and MiquelonSt. ThomasSt. Vincent/GrenadineSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTahitiTaiwanTajikistanTanzaniaThailandTinianTogoTokelauTongaTortolaTrinidad and TobagoTrukTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnion IslandUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUSSR (former)UzbekistanVanuatuVatican City State (Holy See)VenezuelaVietnamVirgin GordaVirgin Islands (British)Virgin Islands (U.S.)WalesWallis and Futuna IslandsWestern SamoaYapYemenYugoslaviaZaireZambiaZimbabwe
