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EU Green Card Lottery
The EU Green Card Lottery registration

ELECTRONIC EU GREEN CARD ENTRY FORM

Applicant Information

1. Name

a. Last/Family Name

No Last/Family Name

b. First Name

No First Name

c. Middle Name

No Middle Name

2. Birth Date

3. Gender

Male

Female

4. Birth City and Country

Birth City/Town/Country Unknown

5. Country of Residence

6. Primary Photograph

Photograph File Name (2Mo Max)

7. Mailing Address

7a. In Care Of
7b. Postal Address
7c. City/Town
7d. District/County/Province/State
7e. Postal Code/Zip Code	No Postal Code/Zip Code
7f. Country

8. Phone Number

Optional

9. E-mail Address

10. EU Destinations

You MUST choose your three favourite destinations.

First choice:
Second choice:
Third choice:
(OR : Outermost regions ; OCT: Overseas countries and territories ; EU2SA: European Union's States Sovereign Area) more...

11. Are You Married?

Unmarried

Married

Divorced

Widowed

Separated

Legally Separated

12. Number of Children

(Unmarried and under 14 years of age)

13. Additionnal Information

I have a job offer

I have a PhD

I am a self-employed worker

I have a sickness insurance

Currently, I earn more than 10.000 ? per year

I want to add value to the EU (investment / transfer of technology / job creation)

European Union Green Card Lottery has been recommended to me by :

I agree with the EU Green Card Lottery terms of use and privaty policy.
(Please confirm, you have read and accept terms of use and privaty policy and you can continue.)

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