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Information Technology Services
105 Lovejoy
4201 Mayflower Hill
Waterville, ME 04901-8842
P: 207-859-4201
F: 207-872-3076
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Form Element Sample 2
*First Name:
Please use standard capitalization for all fields.
Middle Initial:
Last Name:
Address Line 1:
Address Line 2:
City:
State/Province:
--Select--
Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
Armed Forces Africa - Canada - Europe - Middle East
Armed Forces Americas (except Canada)
Armed Forces Pacific
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Marshall Islands
Maryland
Massachusetts
Michigan
Micronesia
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Brunswick
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New Jersey
New Mexico
New York
Newfoundland and Labrador
North Carolina
North Dakota
Northern Mariana Islands
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Palau
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
Enter your state/province if applicable
Zip:
Preferred Email Address:
Enter your email address (for confirmations)
