Online Registration | USA Green Card

Application

Full Name

First Name	Middle Name	Last Name

Birth Date

Day	Month	Year

Gender

Birth Place

City/Town	State/Province

Country

Country Claimed

Indicate the country you are claiming in order to participate in the Lottery. Normally, this is the country in which you were born. If your birth country is not eligible for participation in the Green Card Lottery, indicate the eligible country in which your spouse or either parent was born.

Explanation of Country Claimed

If you are claiming a country that is not the country in which you were born, please explain why.

In what country do you live today?

Education Level

What is the highest level of education you have achieved?

Contact Information

Mailing Address

Address

City/Town	State/Province	Postal Code

Country

Telephone

Confirm Email

Marital Status and Number of Children

What is your marital status?
Number of Children
Optional Information
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How did your hear about or find us?
Affiliate ID (optional)