National Visa Registry www

National Visa Registry
www .nationalvisaregistry.com

National Visa Registry
PMB 725		E-Mail info@usvisaservices.com
16161 Ventura Boulevard		HOME PAGE: http://www.nationalvisaregistry.com
ENCINO, CALIFORNIA 91436		TELEPHONE: (818) 784-4618 FACSIMILE (818) 905-1937

DATA SHEET-Page 1

Complete in ENGLISH

DV-1 Green Card Lottery .

Instruction Sheet

REGISTER NOW FOR THE DV-1- DIVERSITY VISA LOTTERY (GREEN CARD LOTTERY)

We, at the National Visa Registry , founded the YEAR ROUND LOTTERY REGISTRATION CENTER to assist people around the world in properly registering for the Green Card Lottery for as little as $21.25 per application. We guarantee that your application will be mailed within the correct window. If your signed original application(s) and photographs arrive at our office late, we will automatically register you for the next year's DV lottery.

This packet should contain the following :

DATA SHEET – Page One & Page Two : Please complete all sections and sign. Payment information is contained on Page Two. All orders must be pre-paid. Also XX which program is wanted.

DV-PROGRAM APPLICATION : Please download and sign one application for each year that you are registering for.(If you are registering for Husband and Wife for 2 years, each of you must sign 2 application forms).Make sure that the each application is one page. If you did not use our online registration process, please leave the "Application" blank. We will print the required information for you.

NEW PHOTOGRAPH REQUIREMENT : Please provide ONE recent passport style photograph of yourself, your spouse and each of your children and send them with your signed forms for each year you are registering for. (Example: If you are married with 2 children and apply for 2 people 1 year, MUST recieve 2 photos of you, 2 photos of your spouse and 2 photos of each of your children, a total of 8 photos. Each person must have their own, separate photograph.) The size of each photograph must be 2 inches square, or 50 x 50 mm., facing forward. Color or black-and-white photographs are acceptable. ATTACH PHOTO TO APPLICATION WITH CLEAR PIECE OF TAPE. ON THE BACK OF THE PHOTO, PLEASE WRITE YOUR FULL NAME AND DATE OF BIRTH AS SHOWN IN THE PICTURE BELOW.
Separate photographs are required for the applicant, their spouse (husband/wife) and all children under 21 years of age. All photographs must be 2 inches (50mm) square. The person being photographed must face the camera directly without tilting their head in any direction. The person being photographed must not wear anything on their head that would partially hide any part of their face (hat, sunglasses, scarf, etc.). The photograph must be in focus. The photograph can be either color or black and white

ACT NOW-DO NOT DELAY .. Please SIGN the number of DV-PROGRAM APPLICATION(S) needed per number of years that you are registering for and return them to us WITH YOUR PHOTOGRAPHS as soon as possible to all owour office sufficient time to review and prepare your entry ( If you register for 4 years, make sure you have 4 originally signed DV-Program Applications & 4 Photographs).Should you have any further questions, please do not hesitate to contact us.

Very truly yours,

National Visa Registry ,

** Please also include a passportstylephoto (1.5 inches square, or 37x37 mm) for yourself and **
** your spouse (if applicable) when returning these forms for each year thatyouare registering for **

1. PRINCIPAL APPLICANT (1-1) Last Name :______________________________________

(1-2) First Name :______________________(1-3) Middle Name :__________________________

2. DATE OF BIRTH :____________________ 3. PLACE OF BIRTH :___________________________
(Day/Month /Year) (City,Province,Country )

4. EDUCATION OF PRINCIPAL APPLICANT :             5. GENDER :____ Male ____ Female
   a) I am a high school graduate ____Yes ____No
   b) Check the highest level of education completed:
       ____High School, No Degree ____HighSchoolDiploma ____University Degree

6. LASTOR CURRENT RESIDENCE :___________________________________________________
OUTSIDE THE U.S. (City,Province, Country)

7. SPOUSE'S INFORMATION - Last Name :________________________________________

First Name :______________________ MiddleName :__________________________

8. DATE OF BIRTH :_________________ PLACE OF BIRTH :_________________________________
(Spouse) Day/ Month/Year (Spouse) (City)(Country) (Country)

9. EDUCATION OF SPOUSE :      a) I am ahighschool graduate____Yes ____No
                            b)Check the highest level of education completed:
        ____High School, No Degree ____HighSchoolDiploma ____University Degree

10. GENDER OF SPOUSE : ____Male ____Female

11. Last or current residence outside the U.S :________________________________________________
        .                                                                       (City,Province, Country)
12. NAME OF CHILD                                     Date of Birth                                  Place of Birth
(Last, First,Middle)                                       (Day /Month /Year)      (City, Province, Country)

____________________________ _______________ __________________________________

Please provide us with your contact information. (This can be your informationabroad or in theU.S. or this can be your relative or friend in the U.S. who should be ourprimary contact)

APPLICANT'S Name_________________________________________________________________

Address___________________________________________________________________________

Home Telephone_____________________WorkTelephone______________________FAX___________________

I heard about your office from______________________________E-MailAddress_______________________________

National Visa Registry offers you the option to pay for yourapplicationfor up to four years in advance for a substantial DISCOUNT. If you are one ofthe 55,000lucky winners, any unused portion of your payment will be credited towards ourfee inpreparing your adjustment of status papers.

Select Program:

__ Single Entry - I am not married and I have no children under 21 years of age. ___$50.00 - 1 Year

___$90.00 - 2 Year

__ Family Entry - I am married and/or have children under 21 years of age. ___$75.00 - 1 Year

___$125.00 - 2 Year

__ Double Entry - Twice the chances of winning! (Husband & Wife must each complete separate application. ___$125.00 - 1 Year

___$199.00 - 2 Year

PAYMENT INFORMATION:
Checks , Money Orders & Cashier's Checks Must be payable to "US Visa Services" (check one box)

_____U.S. Money Order or Cashier's Check _____International Money Order ____Check Drawn on U.S. Bank

Charge: _____ MASTERCARD ___ VISA ____ DISCOVER _____ AMERICAN EXPRESS

Card No.____________________________________ExpirationDate_________________________________

Cardholder sign here: X__________________________ PRINTCardholdername:____________________________

I have read the information provided by the National Visa Registry concerningtheDiversity Visa (DV-1) Immigrant Visa Program (pursuant to the Immigration Act of 1990)andagree to provide accurate information. I understand that there is no guarantee that Iwillbe successful in this application and that National Visa Registry will undertake theirbestefforts on my behalf. I nevertheless wish to apply, and I also understand that theserviceprovided will be limited to submission of the application only. If additionallyretainedlater, further services relating to immigrant visa processing or adjustment ofstatus maybe provided. I have read and fully understand the contents of this Agreement,and I acceptthese terms of limited representation.

PRINCIPAL APPLICANT (signature)________________________DATE__________________________________

print this page

F. Applicant’sSignature x_________________________________________
( Sign Here )

G. Applicant’sPassport Size Photograph ( -blnksig )

__ Single Entry - I am not married and I have no children under 21 years of age.	___$50.00 - 1 Year
	___$90.00 - 2 Year
__ Family Entry - I am married and/or have children under 21 years of age.	___$75.00 - 1 Year
	___$125.00 - 2 Year
__ Double Entry - Twice the chances of winning! (Husband & Wife must each complete separate application.	___$125.00 - 1 Year
	___$199.00 - 2 Year