IMMIGRATION LOTTERY SUBSCRIPTION PAGE

Welcome to the Immigration Lottery Subscription page. This page is for all Immigration Lottery applications who wish to pre-register for the next U.S. Immigration Lottery. By completing this form you are authorizing the Law Offices of Joan Mathieu to submit your lottery application(s) in accordance with the eligibility requirements in effect at the time specified by the US Government authorities. This service includes the availability of an attorney to answer any questions you may have concerning the lottery. The service also assures you that your application will be promptly filed by an attorney and be in complete compliance with all applicable regualtions. Be sure to answer ALL questions accurately. Upon completing and sending this form, you will receive immediate e-mail confirmation of your Subscription. Please insure that your email address is correctly entered in the form so that we can update you as part of our service.. Thank you.


Diversity Visa Program - Subscription Form

Applicant
Name:
Date of Birth:    
Place of Birth:
Street Address:
City:
State/Province:
Country:
Business Phone:
Business Fax:
E-Mail Address:

Applicant's Spouse
Surname:
First Name:
Middle Name:
Date of Birth:
Month:
Day:
Year:
Place of Birth:
Street Address:
City:
State/Province:
Country:
Business Phone:
Business Fax:
E-Mail Address:


Unmarried Children Under the Age of 21.

Your Comments, Questions, Suggestions:


Order Options
I am ordering:
I am paying by :
I am paying by credit card as follows:
Name on credit card:
Credit Card Number:
Card Expiration Date: Month: Year:


Note: All payments must be in US Dollars only.


[Lottery Page]