(505) 865-4604
[email protected]
Download App
Online Pharmacy
Book Appointment
Home
About
Our Team
Reviews
Photo Gallery
Careers
Contact
Services
Small Animal Services
Large Animal Services
Equine Services
Exotic Animal Services
View All Services
Resources
Online Forms
New Client Form
Drop Off Form
Semen/Ovum Contract
Payment Options
Our App
FAQs
Emergency C-Section
Repro NM
Book Appointment
Home
About
Our Team
Reviews
Photo Gallery
Careers
Contact
Services
Small Animal Services
Large Animal Services
Equine Services
Exotic Animal Services
View All Services
Resources
Online Forms
New Client Form
Drop Off Form
Semen/Ovum Contract
Payment Options
Our App
FAQs
Emergency C-Section
Repro NM
Book Appointment
Welcome New Clients!
Book today
and get $25 off your first exam! *Terms Apply
Online Forms
Semen/Ovum Contract
Get Started
Semen/Ovum Collection, Freezing, & Storage Contract
Thank you for choosing
Los Lunas Animal Clinic
. Please read the following contract and sign.
This Contract must be carefully read, completed, and signed prior to the collection, freezing, and storage of Semen/Ovum.
This Semen / Ovum Collection, Freezing & Storage Contract (hereinafter Contract) is hereby entered into between the Los Lunas Animal Clinic and the individual Owner(s) of the animal identified and described below.
I, we, hereby authorize Repro New Mexico, also known as International Canine Semen Bank New Mexico (ICSB NM) at Los Lunas Animal Clinic (hereinafter LLAC) to collect, freeze and store Semen/Ovum from the following animal:
Animal's Identification Information
A copy of the Animal’s Registration must be provided and confirmed prior to collection.
Species
(Required)
Breed
(Required)
Registry Number
(Required)
DNA Number
(Required)
Microchip Number
(Required)
Color
(Required)
Registered Name
(Required)
Nickname
(Required)
The individual(s) presenting the animal to be collected is the animal’s:
(Required)
Owner
Co-Owner
Agent
If “Agent”, Agent must present proper written authorization for authority to enter into this contract on behalf of the Owner(s).
Owner's Name
(Required)
First
Last
Owner's Signature
(Required)
Owner's Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Owner's Primary Phone
(Required)
Phone Type
(Required)
Home
Cell
Work
Additional Phone
Phone Type
Home
Cell
Work
Additional Phone
Phone Type
Home
Cell
Work
Owner's Email
(Required)
Co-Owner's Name
First
Last
Co-Owner's Signature
Co-Owner's Address
Same as Owner's
Enter New Address
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Co-Owner's Primary Phone
Phone Type
Home
Cell
Work
Additional Phone
Phone Type
Home
Cell
Work
Additional Phone
Phone Type
Home
Cell
Work
Co-Owner's Email
Consent
(Required)
1.
Ownership
- If Owner is an individual, then Owner represents and warrants he/she is the sole and true Owner of the animal and Semen/Ovum, and he/she has full power and authority to enter into this Contract. If Owner is a corporation, syndicate, partnership or party to a co-ownership (hereinafter Entities), then the Agent (whether an actual Owner or other individual acting on behalf of the Entities) represents and warrants Agent has the requisite power and authority to enter into and consummate the transactions contemplated under this Contract and carry out Owners’ obligations hereunder. Owner/Agent certifies the execution, delivery and performance of the transactions contemplated by this Contract have been duly authorized in writing by all Entities. (Hereinafter referred to as “Owner” only).
In the event multiple Owners are signatories to this Contract, all actions requested to be made by LLAC under this Contract will require written authorization from each Owner. In the event LLAC receives conflicting instructions from Owners signatory to this Contract, Owners agree LLAC will not take any action except to store the Semen/Ovum until complete resolution of the conflict and LLAC has been provided written instructions signed by each Owner (whether individuals or entitles).
In the event an Agent signs this Contract on behalf of the Owners / Entities, Agent assumes all responsibility for providing LLAC with a copy of this Contract signed by each Owner / Entity with Thirty (30) days of the date of this Contract or prior to any use, transfer or shipment of the Semen/Ovum. Agent also assumes all financial and legal responsibilities associated with the collection and storage of Semen/Ovum under the terms of this Contract until such time as the Contract is signed by each Owner / Entity and received by LLAC. Agent agrees he/she has no legal rights to Semen/Ovum unless directly specified in writing by Owners/Entities to LLAC.
If LLAC does not receive a copy of this Contract signed by each Owner/Entity within Thirty (30) days of the date this Contract is signed by Agent, LLAC may, in its sole discretion, destroy the Semen/Ovum.
2.
Regulatory Paperwork
- LLAC follows the rules and procedures set by the American Kennel Club (“AKC”) for the provision of services provided under this Contract, regardless of the registry organization with which the animal is registered. All compliance with the rules and procedures of the applicable registry organization is the sole responsibility of the Owner. LLAC does not undertake any responsibility in this regard. Owner agrees to provide LLAC with all required paperwork (including, without limitation, a copy of the registry organization registration and a DNA certificate) at the time the animal is first presented to LLAC for Semen/Ovum collection.
If DNA certification has not been done prior to first collection, LLAC agrees to provide information and necessary paperwork to submit a DNA sample to the applicable registry organization. Owner agrees to provide LLAC with a copy of the certification. If such paperwork has not been provided at the time of Semen/Ovum collection, LLAC may proceed with the collection; however, frozen Semen/Ovum will not be released until all paperwork is provided by Owner. LLAC will continue storing the Semen/Ovum as long as storage fees are paid.
3.
Reproductive Evaluations; Quality of Semen / Ovum
- Owner authorizes LLAC to examine and perform a reproductive evaluation on the animal, if LLAC deems it necessary or advisable. LLAC is authorized to collect, freeze and store Semen/Ovum at any time animal is presented to LLAC by Owner. Owner also acknowledges and agrees Semen/Ovum may not be frozen each time animal is presented if LLAC believes the quality is not sufficient for successful freezing. LLAC makes every effort to successfully freeze Semen/Ovum from every collection.
LLAC DOES NOT MAKE ANY REPRESENTATION OR WARRANTY REGARDING THE RESULTS FROM TREATMENT, ARTIFICIAL INSEMINATION AND/OR THE USE AND VIABILITY OF FROZEN SEMEN / OVUM.
4.
Semen / Ovum Handling Procedures
- LLAC agrees to collect, freeze and store Semen/Ovum from the above-identified animal after all paperwork is received by LLAC. Instructions will be supplied to the designated Semen/Ovum Owner after the Semen/Ovum has been stored. The frozen Semen/Ovum will be available to the Semen/Ovum Owner(s) for use/shipping following standard procedures. Initial collection, freezing and storage fees will include the first year of Semen/Ovum storage. Freezing and storage are charged at the time of collection and annually thereafter. Subsequent years may be pre-paid, or paid on a yearly basis, at the Owner’s discretion. Short-term storage is available (in thirty (30) day increments) if requested. All paperwork for short-term storage must be completed in the same manner as for long-term storage.
Semen/Ovum storage prices are subject to change at any time. Accounts must be current in order for frozen Semen/Ovum to be released by LLAC. There are additional fees charged by LLAC when the stored Semen/Ovum is shipped for breeding or transfer. These fees are usually termed shipping preparation, shipping tank rental, actual shipping charges to ship the Semen/Ovum to its destination, for the return of LLAC’s empty tank and ownership transfer.
5.
Shipping of Semen / Ovum
- Owner(s) will give LLAC at least seven (7) business days advance written notice of any shipping requests with complete written shipping instructions. LLAC will make a good faith effort to accommodate shipping requests or changes to shipping requests made after the initial shipping request due date at an additional charge. LLAC will not be responsible to Owner(s) or any third party, for direct or indirect damages resulting from LLAC’s inability to accommodate such requests or changes. LLAC will not be responsible for any shipping delays if caused by any event beyond LLAC’s control.
6.
Payment
- All fees are due at the time of service. Returned checks are subject to a $30 fee. Outstanding balances are subject to 1.5 % per month (18% APR) interest if the account is greater than thirty (30) days past due. After 180 days (six months) of non-payment, the frozen Semen/Ovum will be deemed abandoned by Owner(s) and subject to disposal at LLAC’s discretion and the account will be submitted to a collection agency. Should legal action be necessary to collect the account, Owner will be responsible for all attorney fees and costs. Prior to the disposal of any Semen/Ovum for non-payment, LLAC will send a registered letter, return receipt requested, by U. S. Mail to the Owner’s address as set out in this Contract, in an effort to communicate with the Owner(s).
IT IS THE OWNER(S) RESPONSIBILITY TO INFORM LLAC, IN WRITING, OF ANY CHANGES TO OWNER’S BILLING (MAILING) ADDRESS.
7.
Sale of Semen / Ovum
- The sale or transfer of Semen/Ovum to new owners is the sole responsibility of the Owner(s). All paperwork (including registry paperwork) must be completed by the new owners and a new Semen/Ovum Storage Contract signed for each transfer/sale if the Semen/Ovum in question is to be stored at Repro New Mexico Canine Semen Bank. If the Semen/Ovum is to be stored at another facility, the new owners assume all responsibilities, fees and shipping charges incurred.
8.
No Warranties
- LLAC Makes no representation and extends no condition or warranty of any kind, either express or implied, with respect to the collection, freezing, storage or shipment of Semen/Ovum, other than as specifically provided in this Contract. LLAC expressly disclaims any other warranties of merchantability, quality or fitness for a particular purpose and any other implied warranties with respect to the capabilities, utility or application of Semen/Ovum.
9.
Insurance
- Owner acknowledges LLAC does not provide insurance against damage or loss of Semen/Ovum. Owner agrees it is Owner’s sole responsibility to investigate available insurance and provide any insurance it may desire at Owner’s expense.
10.
Limitation of Liability
- LLAC shall not be liable for any accident, damage or loss of Semen/Ovum, regardless of cause except if accident, damage or loss is caused in its entirety by the gross negligence or willful intent of LLAC while in its direct custody and care. Liability for any damages or alleged damages of any type, will not exceed actual direct damages to the Owner. Actual direct damages will in no event exceed the collection of the same number of breeding units by a Veterinarian at LLAC’s office of new Semen/Ovum from sire/dam or, if sire/dam is not available for collection, another animal of the Owner’s choosing.
11.
Exclusive Remedy
- LLAC agrees to exercise commercially reasonable care in collecting and storing Semen/Ovum, including, without limitation, storage in a secure area, periodic re-vacuuming of older tanks as necessary to minimize risk due to vacuum failure, frequent monitoring of nitrogen levels in storage tanks and “topping up” with nitrogen, regular (every 1 - 3 days) visual inspection of tanks for early signs of vacuum failure, and keeping a “reserve” of nitrogen available, along with spare tanks, to allow quick transfer of straws should a tank fail. Owner acknowledges and agrees failure of a nitrogen tank vacuum can occur at any time without warning. In the event of loss of Semen/Ovum for which LLAC is responsible, Owner’s exclusive remedy is replacement, at LLAC’s office, of new Semen/Ovum from sire/dam or, if sire/dam is not available for collection, another animal of Owner’s choosing. Owner’s agreement to this exclusive remedy is essential consideration to LLAC’s agreement to enter into this Contract.
12.
Indemnification
- Owner(s) shall indemnify and hold LLAC harmless from any and all liability, damage, loss, cost or expense (including, without limitation, reasonable attorneys’ fees and expenses) resulting from any claims or suits brought against LLAC by a third party arising as a result of or in connection with (i) a breach of any of the representations or warranties made by Owner(s) in this Contract or (ii) any third party claim arising from a breach of any such representations or warranties, or (iii) the collection, storage, freezing, shipment or use of Semen/Ovum that is the subject of this Contract. Owner shall indemnify LLAC for any claims made against LLAC in connection with any breeding or co-ownership contract. Owner shall be free to set the breeding fee, and shall be solely responsible for informing the recipient of Semen/Ovum of such fees. Owner is solely responsible for obtaining payment of such fees from recipient.
Los Lunas Animal Clinic (LLAC) as referred to throughout this Contract includes LLAC, its owner, directors, officers, agents and employees, and any of its affiliates, their directors, officers, agents or employees.
This Contract has been duly executed by Owner/Agent, and constitutes the valid and legally binding obligation of Owner/Agent, enforceable against it in accordance with its terms, except as such enforceability may be limited by applicable law.
Sperm cells and ovum will eventually cease living, but no one knows or can predict when this will occur. It can vary from animal to animal. LLAC shall not be liable and cannot guarantee conception from frozen Semen/Ovum, nor can LLAC guarantee the frozen sperm cells or ovum will be viable at the time of thawing for insemination.
I have read and agree
By signature(s) below, Owner/Co-Owner/Agent, I/we understand and agree to all terms and conditions set out in this Contract.
Signature - Owner
(Required)
Printed Name
(Required)
First
Last
Date
(Required)
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Signature - Co-Owner
(Required)
Printed Name
(Required)
First
Last
Date
(Required)
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Signature - Agent
(Required)
Printed Name
(Required)
First
Last
Date
(Required)
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
In the event of my death or permanent incapacitation, I transfer all frozen Semen/Ovum from the above-identified animal to:
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
(Required)
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.