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1. New Petition Background Information * Petition Title: Example: Stop the Hunger in ABC Country Note: Don't use all caps or the word 'Petition' * Petition Target: Example: The Government of ABC Country Note: This is the name of whom your petition is for. * Petition ID: Example: ABCHunger123 (No spaces or special chars. Underscores '_' allowed) Note: URL for your petition: http://www.PetitionNow.com/ABCHunger123 * Category: (select one) Regular Petition * Geography of Petition: (select one) ---------------- non-geographic ---------------- International ---------------- United States ---------------- 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 Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Islamic Republic of Iran Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Korea, Republic of Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Lucia Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Helena St. Kitts And Nevis St. Pierre and Miquelon St. Vincent And The Greadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (Great Britain) United States United States Virgin Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Wallis And Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe * State of Petition: (select one) ---------------- non-geographic ---------------- International ---------------- Outside USA ---------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 2. Petition Statement * Example: We, the undersigned, are asking that you, the congress of ABC country, reconsider the extreme budget cuts made on January 1st, 2005. Thank you for your time. Note: 'Sincerely, The Undersigned' will be automatically added to the end of your petition statement.   3. Configure Petition Form Fields Display Signature Names: Yes No  Note: If 'No', only signature count will show. Example:Comments are enabled by default below. This means users will be able to leave a Text 'Comment'. Field Name Field Type Field Status Text Number Link/URL Yes/No Null Required Optional Text Number Link/URL Yes/No Null Required Optional Text Number Link/URL Yes/No Null Required Optional Text Number Link/URL Yes/No Null Required Optional 4. Petition Author Information * Petition Author: (First Name, Last Name Required) * Your E-mail Adress: E-mail can only end with @eden.rutgers.edu or @rci.rutgers.edu. You will need to confirm your e-mail address. Organization/Group Name: Organization/Group URL: Street Address: City: State: Zip Code: Country: Telephone Number: Allow Contact Sharing to Press: Yes No Note: If the Press contacts us about your petition, do you give us permission to pass along your contact information? Check Yes or No above.