Kuv tuaj yeem paub koj cov ntaub ntawv xa khoom raws li hauv qab no, yog li peb tuaj yeem xa koj qhov txuas xaj kom them:
(1) Lub tuam txhab npe / Lub npe________________
(2) Xov tooj ________________
(3) Chaw nyob ________________
(4) Lub Nroog __________
(5) Xeev ____________
(6) Lub teb chaws ________________
(7) Zip code ________________
(8) Email ________________