personal information
		ms.	mrs.	mr.		first name:		middle initial:		last name:
						city:		state:		zip code:
								AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VA WA WV WI WY
	site submission information:
						name of site:
						site URL   (web address):		type of site:		how did you learn of the site?
								promotional personal government non-profit organization other		friend relative internet television radio co-worker other
						comments: