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2010 Green Card Lottery Application                               

Print and Fill out this application .

  1. Send a color photo of yourself, preferably 2x2 or passport photo, but we can reduce the size if necessary.
  2. Please send Check or Money Order in the amount of $30.00 payable to Culture Connection.
  3. Mail all to:
Green Card Lottery Application

c/o Culture Connection
PO Box 283
E. Flat Rock, NC 28726

Your application is guaranteed to be submitted, only if all of these steps are followed!!
Your application to the Green Card Lottery can not be completed without your photo.

 

Last Name

First Name

Middle Name

Male      

Female

Date of Birth
 (Month /Day/Year)

Birth/City or Town

Native Country
(If other than Birth Country)

Mailing Address

City/Town

District/Province/State

Postal Code/Zip Code

Country

Email Address

Legally Married

Not Legally Married

Number of Children- unmarried under the age of 21, not United States citizens or permanent residents.   

 

Spouse’s Last Name

Spouse’s First Name

Spouse’s
 Middle Name

Male      

Female

Spouse’s
Date of Birth
(Month/Day/Year)

Spouse’s
Birth/City or Town

Spouse’s Birth/Country

Spouse’s
Native Country
(If other than Birth Country)

 
Information about Children- unmarried under the age of 21, which are not United States
citizens or permanent residents (if applies)
Children's Information
Full name  Birth Dates
 Gender City Town of Birth Country of Birth
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

 Check if you have a high school education or have completed a 12-year elementary education or have at least 2 years of work experience in the last 5 years requiring 2 years training or experience to perform.
This web site has been prepared for general information purposes only. The information on this web site is not legal advice. Legal advice is dependent upon the specific circumstances of each situation.  Finally, the information contained in this web site is not guaranteed to be up to date. Therefore, the information contained in this web site cannot replace the advice of competent legal counsel licensed in your state