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            <div align="justify" style="margin-top:3px;margin-left:3px;margin-right:3px;margin-bottom:3px;"><P class=text><FONT face=Arial size=3>Donations to the Medical Mycological Society are most welcome. The MMSA is registered in the state of Georgia as a non-profit organization. Donations will be used to to further the goals of medical mycology education by enabling graduate students to attend medical mycology conferences and workshops. Please submit Credit Card information or send your check to:<BR><BR>Annette W. Fothergill, MA, MBA<BR>Technical Director<BR>Fungus Testing Laboratory<BR>University of Texas<BR>Health Science Center--San Antonio<BR>7703 Floyd Curl Drive<BR>San Antonio, TX 78229<BR></FONT>
<P>
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<P><FONT color=red>*</FONT>First name:</P></TD>
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<P><FONT color=red>*</FONT>Last name:</P></TD>
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<TD vAlign=top>Country: </TD>
<TD><SELECT size=6 name=Country> <OPTION value=US selected>United States</OPTION> <OPTION value=CA>Canada</OPTION> <OPTION value=AL>Albania</OPTION> <OPTION value=DZ>Algeria</OPTION> <OPTION value=AS>American Samoa</OPTION> <OPTION value=AD>Andorra</OPTION> <OPTION value=AI>Anguilla</OPTION> <OPTION value=AG>Antigua</OPTION> <OPTION value=AR>Argentina</OPTION> <OPTION value=AM>Armenia</OPTION> <OPTION value=AW>Aruba</OPTION> <OPTION value=AU>Australia</OPTION> <OPTION value=AT>Austria</OPTION> <OPTION value=AZ>Azerbaijan</OPTION> <OPTION value=AP>Azores</OPTION> <OPTION value=AS>Bahamas</OPTION> <OPTION value=BH>Bahrain</OPTION> <OPTION value=BD>Bangladesh</OPTION> <OPTION value=BB>Barbados</OPTION> <OPTION value=BC>Barbuda</OPTION> <OPTION value=BE>Belgium</OPTION> <OPTION value=BZ>Belize</OPTION> <OPTION value=BY>Belorus</OPTION> <OPTION value=BJ>Benin</OPTION> <OPTION value=BM>Bermuda</OPTION> <OPTION value=BO>Bolivia</OPTION> <OPTION value=BL>Bonaire</OPTION> <OPTION value=BA>Bosnia</OPTION> <OPTION value=BW>Botswana</OPTION> <OPTION value=BR>Brazil</OPTION> <OPTION value=VG>British Virgin Islands</OPTION> <OPTION value=BN>Brunei</OPTION> <OPTION value=BG>Bulgaria</OPTION> <OPTION value=BF>Burkina Faso</OPTION> <OPTION value=BI>Burundi</OPTION> <OPTION value=KH>Cambodia</OPTION> <OPTION value=CM>Cameroon</OPTION> <OPTION value=CE>Canary Islands</OPTION> <OPTION value=CV>Cape Verde Islands</OPTION> <OPTION value=KY>Cayman Islands</OPTION> <OPTION value=CF>Central African Republic</OPTION> <OPTION value=TD>Chad</OPTION> <OPTION value=NN>Channel Islands</OPTION> <OPTION value=CL>Chile</OPTION> <OPTION value=CN>China, Peoples Republic of</OPTION> <OPTION value=CX>Christmas Island</OPTION> <OPTION value=CC>Cocos Islands</OPTION> <OPTION value=CO>Colombia</OPTION> <OPTION value=CG>Congo</OPTION> <OPTION value=CK>Cook Islands</OPTION> <OPTION value=CR>Costa Rica</OPTION> <OPTION value=HR>Croatia</OPTION> <OPTION value=CB>Curacao</OPTION> <OPTION value=CY>Cyprus</OPTION> <OPTION value=CZ>Czech Republic</OPTION> <OPTION value=DK>Denmark</OPTION> <OPTION value=DJ>Djibouti</OPTION> <OPTION value=DM>Dominica</OPTION> <OPTION value=DO>Dominican Republic</OPTION> <OPTION value=EC>Ecuador</OPTION> <OPTION value=EG>Egypt</OPTION> <OPTION value=SV>El Salvador</OPTION> <OPTION value=EN>England</OPTION> <OPTION value=GQ>Equitorial Guinea</OPTION> <OPTION value=ER>Eritrea</OPTION> <OPTION value=EE>Estonia</OPTION> <OPTION value=ET>Ethiopia</OPTION> <OPTION value=FO>Faeroe Islands</OPTION> <OPTION value=FJ>Fiji</OPTION> <OPTION value=FI>Finland</OPTION> <OPTION value=FR>France</OPTION> <OPTION value=GF>French Guiana</OPTION> <OPTION value=PF>French Polynesia</OPTION> <OPTION value=GA>Gabon</OPTION> <OPTION value=GM>Gambia</OPTION> <OPTION value=GE>Georgia</OPTION> <OPTION value=DE>Germany</OPTION> <OPTION value=GH>Ghana</OPTION> <OPTION value=GI>Gibraltar</OPTION> <OPTION value=GR>Greece</OPTION> <OPTION value=GL>Greenland</OPTION> <OPTION value=GD>Grenada</OPTION> <OPTION value=GP>Guadeloupe</OPTION> <OPTION value=GU>Guam</OPTION> <OPTION value=GT>Guatemala</OPTION> <OPTION value=GN>Guinea</OPTION> <OPTION value=GW>Guinea-Bissau</OPTION> <OPTION value=GY>Guyana</OPTION> <OPTION value=HT>Haiti</OPTION> <OPTION value=HO>Holland</OPTION> <OPTION value=HN>Honduras</OPTION> <OPTION value=HK>Hong Kong</OPTION> <OPTION value=HU>Hungary</OPTION> <OPTION value=IS>Iceland</OPTION> <OPTION value=IN>India</OPTION> <OPTION value=ID>Indonesia</OPTION> <OPTION value=IR>Iran</OPTION> <OPTION value=IE>Ireland</OPTION> <OPTION value=IL>Israel</OPTION> <OPTION value=IT>Italy</OPTION> <OPTION value=CI>Ivory Coast (Cote d'Ivoire)</OPTION> <OPTION value=JM>Jamaica</OPTION> <OPTION value=JP>Japan</OPTION> <OPTION value=JO>Jordan</OPTION> <OPTION value=KZ>Kazakhstan</OPTION> <OPTION value=KE>Kenya</OPTION> <OPTION value=KI>Kiribati</OPTION> <OPTION value=KR>Korea, South</OPTION> <OPTION value=KO>Kosrae</OPTION> <OPTION value=KW>Kuwait</OPTION> 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value=MM>Myanmar</OPTION> <OPTION value=NA>Namibia</OPTION> <OPTION value=NP>Nepal</OPTION> <OPTION value=NL>Netherlands</OPTION> <OPTION value=AN>Netherlands Antilles</OPTION> <OPTION value=NV>Nevis</OPTION> <OPTION value=NC>New Caledonia</OPTION> <OPTION value=NZ>New Zealand</OPTION> <OPTION value=NI>Nicaragua</OPTION> <OPTION value=NE>Niger</OPTION> <OPTION value=NG>Nigeria</OPTION> <OPTION value=NU>Niue</OPTION> <OPTION value=NF>Norfolk Island</OPTION> <OPTION value=NB>Northern Ireland</OPTION> <OPTION value=MP>Northern Mariana Islands</OPTION> <OPTION value=NO>Norway</OPTION> <OPTION value=OM>Oman</OPTION> <OPTION value=PK>Pakistan</OPTION> <OPTION value=PW>Palau</OPTION> <OPTION value=PA>Panama</OPTION> <OPTION value=PG>Papua New Guinea</OPTION> <OPTION value=PY>Paraguay</OPTION> <OPTION value=PE>Peru</OPTION> <OPTION value=PH>Philippines</OPTION> <OPTION value=PL>Poland</OPTION> <OPTION value=PO>Ponape</OPTION> <OPTION value=PT>Portugal</OPTION> <OPTION value=PR>Puerto Rico</OPTION> <OPTION value=QA>Qatar</OPTION> <OPTION value=RE>Reunion</OPTION> <OPTION value=RO>Romania</OPTION> <OPTION value=RT>Rota</OPTION> <OPTION value=RU>Russia</OPTION> <OPTION value=RW>Rwanda</OPTION> <OPTION value=SS>Saba</OPTION> <OPTION value=SP>Saipan</OPTION> <OPTION value=SM>San Morino</OPTION> <OPTION value=SA>Saudi Arabia</OPTION> <OPTION value=SF>Scotland</OPTION> <OPTION value=SN>Senegal</OPTION> <OPTION value=SC>Seychelles</OPTION> <OPTION value=SL>Sierra Leone</OPTION> <OPTION value=SG>Singapore</OPTION> <OPTION value=SK>Slovak Republic</OPTION> <OPTION value=SI>Slovenia</OPTION> <OPTION value=SB>Solomon Islands</OPTION> <OPTION value=ZA>South Africa</OPTION> <OPTION value=ES>Spain</OPTION> <OPTION value=LK>Sri Lanka</OPTION> <OPTION value=NT>St. Barthelemy</OPTION> <OPTION value=SW>St. Christopher</OPTION> <OPTION value=SX>St. Croix</OPTION> <OPTION value=EU>St. Eustatius</OPTION> <OPTION value=UV>St. John</OPTION> <OPTION value=KN>St. Kitts</OPTION> <OPTION value=LC>St. Lucia</OPTION> <OPTION value=MB>St. Maarten</OPTION> <OPTION value=TB>St. Martin</OPTION> <OPTION value=VL>St. Thomas</OPTION> <OPTION value=VC>St. Vincent and the Grenadines</OPTION> <OPTION value=SD>Sudan</OPTION> <OPTION value=SR>Suriname</OPTION> <OPTION value=SZ>Swaziland</OPTION> <OPTION value=SE>Sweden</OPTION> <OPTION value=CH>Switzerland</OPTION> <OPTION value=SY>Syria</OPTION> <OPTION value=TA>Tahiti</OPTION> <OPTION value=TW>Taiwan</OPTION> <OPTION value=TJ>Tajikistan</OPTION> <OPTION value=TZ>Tanzania</OPTION> <OPTION value=TH>Thailand</OPTION> <OPTION value=TI>Tinian</OPTION> <OPTION value=TG>Togo</OPTION> <OPTION value=TO>Tonga</OPTION> <OPTION value=TL>Tortola</OPTION> <OPTION value=TT>Trinidad and Tobago</OPTION> <OPTION value=TU>Truk</OPTION> <OPTION value=TN>Tunisia</OPTION> <OPTION value=TR>Turkey</OPTION> <OPTION value=TM>Turkmenistan</OPTION> <OPTION value=TC>Turks and Caicos Islands</OPTION> <OPTION value=TV>Tuvalu</OPTION> <OPTION value=VI>U.S. Virgin Islands</OPTION> <OPTION value=UG>Uganda</OPTION> <OPTION value=UA>Ukraine</OPTION> <OPTION value=UI>Union Island</OPTION> <OPTION value=AE>United Arab Emirates</OPTION> <OPTION value=GB>United Kingdom</OPTION> <OPTION value=UY>Uruguay</OPTION> <OPTION value=UZ>Uzbekistan</OPTION> <OPTION value=VU>Vanuatu</OPTION> <OPTION value=VE>Venezuela</OPTION> <OPTION value=VN>Vietnam</OPTION> <OPTION value=VR>Virgin Gorda</OPTION> <OPTION value=WK>Wake Island</OPTION> <OPTION value=WL>Wales</OPTION> <OPTION value=WF>Wallis and Futuna Islands</OPTION> <OPTION value=WS>Western Samoa</OPTION> <OPTION value=YA>Yap</OPTION> <OPTION value=YE>Yemen</OPTION> <OPTION value=YU>Yugoslavia</OPTION> <OPTION value=ZR>Zaire</OPTION> <OPTION value=ZM>Zambia</OPTION> <OPTION value=ZW>Zimbabwe</OPTION></SELECT> </TD></TR>
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 <br>
<input type="radio" name="donAmt" value="<input type="radio" name="donAmt" value="100"> $100 Patron<br>
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 <br>
<input type="radio" name="donAmt" value="<input type="radio" name="donAmt" value="500"> $500 Silver<br>
"> $<input type="radio" name="donAmt" value="500"> $500 Silver<br>
 <br>
<input type="radio" name="donAmt" value="<input type="radio" name="donAmt" value="1000"> $1000 Gold<br>
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 <br>
<input type="radio" name="donAmt" value=""> $ <br>
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