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        <h1>
            Child Pornography and Exploitation Reporting Form</h1>
        <table>
            <tr>
                <td>
                    <table style="width: 100%;">
                        <tr>
                            <td style="width: 600px" colspan="2">
                                You can use this form to report child pornography and exploitation on Charter’s
                                network. Please complete and submit it with as much information as possible. Required
                                fields are marked with an asterisk. NOTE: If you have information regarding a child
                                who is currently being harmed or exploited, you should immediately contact your
                                local law enforcement.
                            </td>
                        </tr>
                        <tr>
                            <td colspan="2">
                                <br />
                                <h2>
                                    Reporter</h2>
                                <p class="style7">
                                    <sup><span style="color: #ff0000;">*</span></sup><span class="style9">Indicates Required Fields</span></p>
                            </td>
                        </tr>
                        <tr>
                            <td style="width: 101px" align="left">
                                <sup><span style="color: #ff0000;">*</span></sup>First Name:</td>
                            <td align="left">
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                                <sup><span style="color: #ff0000;">*</span></sup>Last Name:</td>
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                                <asp:RequiredFieldValidator ID="RequiredFieldValidator1" runat="server" Text="<img src='../Images/error-icon_small.gif'/>"
                                    ControlToValidate="txtLastName" Display="Dynamic" ErrorMessage="<b>Last Name</b> is required."></asp:RequiredFieldValidator></td>
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                                <sup><span style="color: #ff0000;">*</span></sup>Street Address:</td>
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                            <td style="width: 101px;" align="left">
                                <sup><span style="color: #ff0000;">*</span></sup>City:</td>
                            <td align="left">
                                <asp:TextBox ID="txtCity" runat="server" MaxLength="100"  Width="425px" />
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator3" runat="server" Text="<img src='../Images/error-icon_small.gif'/>"
                                    ControlToValidate="txtCity" Display="Dynamic" ErrorMessage="<b>City</b> is required."></asp:RequiredFieldValidator></td>
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                        <tr>
                            <td style="width: 101px" align="left">
                                <sup><span style="color: #ff0000;">*</span></sup>State:</td>
                            <td style="width: 178px" align="left">
                                <asp:DropDownList ID="ddlState" runat="server" Style="width: 176px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="AL">Alabama</asp:ListItem>
                                    <asp:ListItem Value="AK">Alaska</asp:ListItem>
                                    <asp:ListItem Value="AZ">Arizona</asp:ListItem>
                                    <asp:ListItem Value="AR">Arkansas</asp:ListItem>
                                    <asp:ListItem Value="CA">California</asp:ListItem>
                                    <asp:ListItem Value="CO">Colorado</asp:ListItem>
                                    <asp:ListItem Value="CT">Connecticut</asp:ListItem>
                                    <asp:ListItem Value="DE">Delaware</asp:ListItem>
                                    <asp:ListItem Value="DC">District of Columbia</asp:ListItem>
                                    <asp:ListItem Value="FL">Florida</asp:ListItem>
                                    <asp:ListItem Value="GA">Georgia</asp:ListItem>
                                    <asp:ListItem Value="GU">Guam</asp:ListItem>
                                    <asp:ListItem Value="HI">Hawaii</asp:ListItem>
                                    <asp:ListItem Value="ID">Idaho</asp:ListItem>
                                    <asp:ListItem Value="IL">Illinois</asp:ListItem>
                                    <asp:ListItem Value="IN">Indiana</asp:ListItem>
                                    <asp:ListItem Value="IA">Iowa</asp:ListItem>
                                    <asp:ListItem Value="KS">Kansas</asp:ListItem>
                                    <asp:ListItem Value="KY">Kentucky</asp:ListItem>
                                    <asp:ListItem Value="LA">Louisiana</asp:ListItem>
                                    <asp:ListItem Value="ME">Maine</asp:ListItem>
                                    <asp:ListItem Value="MD">Maryland</asp:ListItem>
                                    <asp:ListItem Value="MA">Massachusetts</asp:ListItem>
                                    <asp:ListItem Value="MI">Michigan</asp:ListItem>
                                    <asp:ListItem Value="MN">Minnesota</asp:ListItem>
                                    <asp:ListItem Value="MS">Mississippi</asp:ListItem>
                                    <asp:ListItem Value="MO">Missouri</asp:ListItem>
                                    <asp:ListItem Value="MT">Montana</asp:ListItem>
                                    <asp:ListItem Value="NE">Nebraska</asp:ListItem>
                                    <asp:ListItem Value="NV">Nevada</asp:ListItem>
                                    <asp:ListItem Value="NH">New Hampshire</asp:ListItem>
                                    <asp:ListItem Value="NJ">New Jersey</asp:ListItem>
                                    <asp:ListItem Value="NM">New Mexico</asp:ListItem>
                                    <asp:ListItem Value="NY">New York</asp:ListItem>
                                    <asp:ListItem Value="NC">North Carolina</asp:ListItem>
                                    <asp:ListItem Value="ND">North Dakota</asp:ListItem>
                                    <asp:ListItem Value="OH">Ohio</asp:ListItem>
                                    <asp:ListItem Value="OK">Oklahoma</asp:ListItem>
                                    <asp:ListItem Value="OR">Oregon</asp:ListItem>
                                    <asp:ListItem Value="PA">Pennsylvania</asp:ListItem>
                                    <asp:ListItem Value="PR">Puerto Rico</asp:ListItem>
                                    <asp:ListItem Value="RI">Rhode Island</asp:ListItem>
                                    <asp:ListItem Value="SC">South Carolina</asp:ListItem>
                                    <asp:ListItem Value="SD">South Dakota</asp:ListItem>
                                    <asp:ListItem Value="TN">Tennessee</asp:ListItem>
                                    <asp:ListItem Value="TX">Texas</asp:ListItem>
                                    <asp:ListItem Value="UT">Utah</asp:ListItem>
                                    <asp:ListItem Value="VT">Vermont</asp:ListItem>
                                    <asp:ListItem Value="VA">Virginia</asp:ListItem>
                                    <asp:ListItem Value="VI">Virgin Islands</asp:ListItem>
                                    <asp:ListItem Value="WA">Washington</asp:ListItem>
                                    <asp:ListItem Value="WV">West Virginia</asp:ListItem>
                                    <asp:ListItem Value="WI">Wisconsin</asp:ListItem>
                                    <asp:ListItem Value="WY">Wyoming</asp:ListItem>
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                                <sup><span style="color: #ff0000;">*</span></sup>Postal Code:</td>
                            <td>
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                                <asp:RequiredFieldValidator ID="RequiredFieldValidator5" runat="server" ControlToValidate="txtReporterPostalCode"
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                                <sup><span style="color: #ff0000;">*</span></sup>Country</td>
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                                    <asp:ListItem Value="United States">
                           United States
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                                    <asp:ListItem Value="Albania">
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                                    <asp:ListItem Value="All others">
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                                    <asp:ListItem Value="Andorra">
                           Andorra
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                                    <asp:ListItem Value="Angola">
                           Angola
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                                    <asp:ListItem Value="Anguilla">
                           Anguilla
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                                    <asp:ListItem Value="Antigua and Barbuda">
                           Antigua and Barbuda
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                                    <asp:ListItem Value="Argentina">
                           Argentina
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                                    <asp:ListItem Value="Armenia">
                           Armenia
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                                    <asp:ListItem Value="Aruba">
                           Aruba
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                                    <asp:ListItem Value="Ashmore and Cartier Islands">
                           Ashmore and Cartier Islands
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                                    <asp:ListItem Value="Australia">
                           Australia
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                                    <asp:ListItem Value="Austria">
                           Austria
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                                    <asp:ListItem Value="Azerbaijan">
                           Azerbaijan
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                                    <asp:ListItem Value="Azores Islands">
                           Azores Islands
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                                    <asp:ListItem Value="Bahamas">
                           Bahamas
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                                    <asp:ListItem Value="Bahrain/Bahrein">
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                                    <asp:ListItem Value="Barbuda and Antigua">
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                                    <asp:ListItem Value="Bassas Da India">
                           Bassas Da India
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                                    <asp:ListItem Value="Belgium">
                           Belgium
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                                    <asp:ListItem Value="Belize">
                           Belize
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                                    <asp:ListItem Value="Benin">
                           Benin
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                                    <asp:ListItem Value="Bermuda">
                           Bermuda
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                                    <asp:ListItem Value="Bhutan">
                           Bhutan
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                                    <asp:ListItem Value="Bolivia">
                           Bolivia
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                                    <asp:ListItem Value="Bonaire">
                           Bonaire
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                                    <asp:ListItem Value="Bosnia and Hercegovenia">
                           Bosnia and Hercegovenia
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                                    <asp:ListItem Value="Botswana">
                           Botswana
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                                    <asp:ListItem Value="Bouvet Island">
                           Bouvet Island
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                                    <asp:ListItem Value="Brazil">
                           Brazil
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                                    <asp:ListItem Value="British Indian Ocean Territory">
                           British Indian Ocean Territory
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                                    <asp:ListItem Value="British Virgin Islands">
                           British Virgin Islands
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                                    <asp:ListItem Value="Brunei">
                           Brunei
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                                    <asp:ListItem Value="Bulgaria">
                           Bulgaria
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                                    <asp:ListItem Value="Burkina Faso">
                           Burkina Faso
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                                    <asp:ListItem Value="Burma">
                           Burma
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                                    <asp:ListItem Value="Burundi">
                           Burundi
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                                    <asp:ListItem Value="Byelarus">
                           Byelarus
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                                    <asp:ListItem Value="Cambodia">
                           Cambodia
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                                    <asp:ListItem Value="Cameroon">
                           Cameroon
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                           Canada
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                                    <asp:ListItem Value="Canary Islands">
                           Canary Islands
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                                    <asp:ListItem Value="Cape Verde Islands">
                           Cape Verde Islands
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                                    <asp:ListItem Value="Cayman Islands">
                           Cayman Islands
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                                    <asp:ListItem Value="Central African Republic">
                           Central African Republic
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                                    <asp:ListItem Value="Chad">
                           Chad
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                                    <asp:ListItem Value="Chile">
                           Chile
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                                    <asp:ListItem Value="Christmas Island">
                           Christmas Island
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                                    <asp:ListItem Value="Clipperton Island">
                           Clipperton Island
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                                    <asp:ListItem Value="Cocos (Keeling) Islands">
                           Cocos (Keeling) Islands
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                                    <asp:ListItem Value="Colombia">
                           Colombia
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                                    <asp:ListItem Value="Comoros">
                           Comoros
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                                    <asp:ListItem Value="Cook Islands">
                           Cook Islands
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                                    <asp:ListItem Value="Coral Sea Islands">
                           Coral Sea Islands
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                                    <asp:ListItem Value="Costa Rica">
                           Costa Rica
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                                    <asp:ListItem Value="Cote d'Ivoire (Ivory Coast)">
                           Cote d'Ivoire (Ivory Coast)
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                                    <asp:ListItem Value="Croatia">
                           Croatia
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                                    <asp:ListItem Value="Cuba">
                           Cuba
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                                    <asp:ListItem Value="Curacao">
                           Curacao
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                                    <asp:ListItem Value="Cyprus">
                           Cyprus
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                                    <asp:ListItem Value="Czech Republic">
                           Czech Republic
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                                    <asp:ListItem Value="Denmark">
                           Denmark
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                                    <asp:ListItem Value="Djibouti">
                           Djibouti
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                                    <asp:ListItem Value="Dominica">
                           Dominica
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                                    <asp:ListItem Value="Dominican Republic">
                           Dominican Republic
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                                    <asp:ListItem Value="Ecuador">
                           Ecuador
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                                    <asp:ListItem Value="Egypt">
                           Egypt
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                                    <asp:ListItem Value="El Salvador">
                           El Salvador
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                                    <asp:ListItem Value="England">
                           England
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                                    <asp:ListItem Value="Equatorial Guinea">
                           Equatorial Guinea
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                                    <asp:ListItem Value="Eretria">
                           Eretria
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                                    <asp:ListItem Value="Estonia">
                           Estonia
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                                    <asp:ListItem Value="Ethiopia">
                           Ethiopia
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                                    <asp:ListItem Value="Europa Island">
                           Europa Island
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                                    <asp:ListItem Value="Falkland Islands">
                           Falkland Islands
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                                    <asp:ListItem Value="Faroe Islands">
                           Faroe Islands
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                                    <asp:ListItem Value="Federated States of Micronesia">
                           Federated States of Micronesia
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                                    <asp:ListItem Value="Fiji">
                           Fiji
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                                    <asp:ListItem Value="Finland">
                           Finland
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                                    <asp:ListItem Value="France">
                           France
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                                    <asp:ListItem Value="French Guiana">
                           French Guiana
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                                    <asp:ListItem Value="French Polynesia">
                           French Polynesia
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                                    <asp:ListItem Value="French Southern and Antartic Lands">
                           French Southern and Antartic Lands
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                                    <asp:ListItem Value="Gabon">
                           Gabon
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                                    <asp:ListItem Value="Gambia, The">
                           Gambia, The
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                                    <asp:ListItem Value="Gaza">
                           Gaza
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                                    <asp:ListItem Value="Georgia">
                           Georgia
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                                    <asp:ListItem Value="Germany">
                           Germany
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                                    <asp:ListItem Value="Ghana">
                           Ghana
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                                    <asp:ListItem Value="Gibraltar">
                           Gibraltar
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                                    <asp:ListItem Value="Glorioso Islands">
                           Glorioso Islands
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                                    <asp:ListItem Value="Greece">
                           Greece
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                                    <asp:ListItem Value="Greenland">
                           Greenland
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                                    <asp:ListItem Value="Grenada">
                           Grenada
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                                    <asp:ListItem Value="Guadeloupe">
                           Guadeloupe
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                                    <asp:ListItem Value="Guatemala">
                           Guatemala
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                                    <asp:ListItem Value="Guernsey">
                           Guernsey
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                                    <asp:ListItem Value="Guiana, French">
                           Guiana, French
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                                    <asp:ListItem Value="Guinea">
                           Guinea
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                                    <asp:ListItem Value="Guinea-Bissau">
                           Guinea-Bissau
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                                    <asp:ListItem Value="Guyana">
                           Guyana
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                                    <asp:ListItem Value="Haiti">
                           Haiti
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                                    <asp:ListItem Value="Heard Island and McDonald Island">
                           Heard Island and McDonald Island
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                                    <asp:ListItem Value="Honduras">
                           Honduras
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                                    <asp:ListItem Value="Hong Kong">
                           Hong Kong
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                                    <asp:ListItem Value="Hungary">
                           Hungary
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                                    <asp:ListItem Value="Iceland">
                           Iceland
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                                    <asp:ListItem Value="India">
                           India
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                                    <asp:ListItem Value="Indonesia">
                           Indonesia
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                                    <asp:ListItem Value="Iran">
                           Iran
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                                    <asp:ListItem Value="Iraq">
                           Iraq
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                                    <asp:ListItem Value="Ireland">
                           Ireland
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                                    <asp:ListItem Value="Isle of Man">
                           Isle of Man
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                                    <asp:ListItem Value="Israel">
                           Israel
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                                    <asp:ListItem Value="Italy">
                           Italy
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                                    <asp:ListItem Value="Jamaica">
                           Jamaica
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                                    <asp:ListItem Value="Jan Mayen">
                           Jan Mayen
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                                    <asp:ListItem Value="Japan">
                           Japan
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                                    <asp:ListItem Value="Jersey">
                           Jersey
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                                    <asp:ListItem Value="Jordan">
                           Jordan
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                                    <asp:ListItem Value="Juan de Nova Island">
                           Juan de Nova Island
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                                    <asp:ListItem Value="Kazakhstan">
                           Kazakhstan
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                                    <asp:ListItem Value="Kenya">
                           Kenya
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                                    <asp:ListItem Value="Kiribati">
                           Kiribati
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                                    <asp:ListItem Value="Kuwait">
                           Kuwait
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                                    <asp:ListItem Value="Kyrgyzstan">
                           Kyrgyzstan
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                                    <asp:ListItem Value="Labrador">
                           Labrador
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                                    <asp:ListItem Value="Laos">
                           Laos
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                                    <asp:ListItem Value="Lebanon">
                           Lebanon
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                                    <asp:ListItem Value="Lesotho">
                           Lesotho
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                                    <asp:ListItem Value="Liberia">
                           Liberia
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                                    <asp:ListItem Value="Libya">
                           Libya
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                                    <asp:ListItem Value="Liechtenstein">
                           Liechtenstein
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                                    <asp:ListItem Value="Lithuania">
                           Lithuania
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                                    <asp:ListItem Value="Luxembourg">
                           Luxembourg
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                                    <asp:ListItem Value="Macau">
                           Macau
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                                    <asp:ListItem Value="Macedonia">
                           Macedonia
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                                    <asp:ListItem Value="Madagascar">
                           Madagascar
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                                    <asp:ListItem Value="Madeira Islands">
                           Madeira Islands
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                                    <asp:ListItem Value="Malagasy Republic">
                           Malagasy Republic
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                                    <asp:ListItem Value="Malawi">
                           Malawi
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                                    <asp:ListItem Value="Malaysia">
                           Malaysia
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                                    <asp:ListItem Value="Maldives">
                           Maldives
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                                    <asp:ListItem Value="Mali">
                           Mali
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                                    <asp:ListItem Value="Malta">
                           Malta
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                                    <asp:ListItem Value="Manahiki Island">
                           Manahiki Island
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                                    <asp:ListItem Value="Martinique">
                           Martinique
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                                    <asp:ListItem Value="Mauritania">
                           Mauritania
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                                    <asp:ListItem Value="Mauritius">
                           Mauritius
                                    </asp:ListItem>
                                    <asp:ListItem Value="Mayotte">
                           Mayotte
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                                    <asp:ListItem Value="McDonald Island and Heard Island">
                           McDonald Island and Heard Island
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                                    <asp:ListItem Value="Mexico">
                           Mexico
                                    </asp:ListItem>
                                    <asp:ListItem Value="Moldova">
                           Moldova
                                    </asp:ListItem>
                                    <asp:ListItem Value="Monaco">
                           Monaco
                                    </asp:ListItem>
                                    <asp:ListItem Value="Mongolia">
                           Mongolia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Montserrat">
                           Montserrat
                                    </asp:ListItem>
                                    <asp:ListItem Value="Morocco">
                           Morocco
                                    </asp:ListItem>
                                    <asp:ListItem Value="Mozambique">
                           Mozambique
                                    </asp:ListItem>
                                    <asp:ListItem Value="Namibia">
                           Namibia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nauru">
                           Nauru
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nepal">
                           Nepal
                                    </asp:ListItem>
                                    <asp:ListItem Value="Netherlands">
                           Netherlands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Netherlands Antilles">
                           Netherlands Antilles
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nevis">
                           Nevis
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nevis and Saint Christopher">
                           Nevis and Saint Christopher
                                    </asp:ListItem>
                                    <asp:ListItem Value="New Caledonia">
                           New Caledonia
                                    </asp:ListItem>
                                    <asp:ListItem Value="New Zealand">
                           New Zealand
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nicaragua">
                           Nicaragua
                                    </asp:ListItem>
                                    <asp:ListItem Value="Niger">
                           Niger
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nigeria">
                           Nigeria
                                    </asp:ListItem>
                                    <asp:ListItem Value="Niue">
                           Niue
                                    </asp:ListItem>
                                    <asp:ListItem Value="Norfolk Island">
                           Norfolk Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="North Korea">
                           North Korea
                                    </asp:ListItem>
                                    <asp:ListItem Value="Northern Ireland">
                           Northern Ireland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Norway">
                           Norway
                                    </asp:ListItem>
                                    <asp:ListItem Value="Okinawa">
                           Okinawa
                                    </asp:ListItem>
                                    <asp:ListItem Value="Oman">
                           Oman
                                    </asp:ListItem>
                                    <asp:ListItem Value="Pakistan">
                           Pakistan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Palau, Republic of">
                           Palau, Republic of
                                    </asp:ListItem>
                                    <asp:ListItem Value="Panama">
                           Panama
                                    </asp:ListItem>
                                    <asp:ListItem Value="Papua New Guinea">
                           Papua New Guinea
                                    </asp:ListItem>
                                    <asp:ListItem Value="Paraguay">
                           Paraguay
                                    </asp:ListItem>
                                    <asp:ListItem Value="Parcel Islands">
                           Parcel Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="People's Republic of China">
                           People's Republic of China
                                    </asp:ListItem>
                                    <asp:ListItem Value="Peru">
                           Peru
                                    </asp:ListItem>
                                    <asp:ListItem Value="Philippines">
                           Philippines
                                    </asp:ListItem>
                                    <asp:ListItem Value="Pitcairn, Henderson, Ducie, and Oeno">
                           Pitcairn, Henderson, Ducie, and Oeno
                                    </asp:ListItem>
                                    <asp:ListItem Value="Poland">
                           Poland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Polynesia, French">
                           Polynesia, French
                                    </asp:ListItem>
                                    <asp:ListItem Value="Portugal">
                           Portugal
                                    </asp:ListItem>
                                    <asp:ListItem Value="Qatar">
                           Qatar
                                    </asp:ListItem>
                                    <asp:ListItem Value="Republic of Congo,">
                           Republic of Congo,
                                    </asp:ListItem>
                                    <asp:ListItem Value="Reunion">
                           Reunion
                                    </asp:ListItem>
                                    <asp:ListItem Value="Romania/Rumania">
                           Romania/Rumania
                                    </asp:ListItem>
                                    <asp:ListItem Value="Russia">
                           Russia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Russian Federation">
                           Russian Federation
                                    </asp:ListItem>
                                    <asp:ListItem Value="Rwanda">
                           Rwanda
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Christopher">
                           Saint Christopher
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Helena">
                           Saint Helena
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Kitts">
                           Saint Kitts
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Lucia">
                           Saint Lucia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Pierre and Miquelon">
                           Saint Pierre and Miquelon
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Vincent and the Grenadines">
                           Saint Vincent and the Grenadines
                                    </asp:ListItem>
                                    <asp:ListItem Value="San Marino">
                           San Marino
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sao Tome and Principe">
                           Sao Tome and Principe
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sardinia">
                           Sardinia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saudi Arabia">
                           Saudi Arabia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Scotland">
                           Scotland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Senegal">
                           Senegal
                                    </asp:ListItem>
                                    <asp:ListItem Value="Seychelles">
                           Seychelles
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sicily">
                           Sicily
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sierre Leone">
                           Sierre Leone
                                    </asp:ListItem>
                                    <asp:ListItem Value="Singapore">
                           Singapore
                                    </asp:ListItem>
                                    <asp:ListItem Value="Slovakia">
                           Slovakia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Slovenia">
                           Slovenia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Solomon Islands">
                           Solomon Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Somalia">
                           Somalia
                                    </asp:ListItem>
                                    <asp:ListItem Value="South Africa">
                           South Africa
                                    </asp:ListItem>
                                    <asp:ListItem Value="South Georgia and the South Sandwich">
                           South Georgia and the South Sandwich
                                    </asp:ListItem>
                                    <asp:ListItem Value="South Korea">
                           South Korea
                                    </asp:ListItem>
                                    <asp:ListItem Value="Spain">
                           Spain
                                    </asp:ListItem>
                                    <asp:ListItem Value="Spratly Islands">
                           Spratly Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sri Lanka">
                           Sri Lanka
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sudan">
                           Sudan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Surinam">
                           Surinam
                                    </asp:ListItem>
                                    <asp:ListItem Value="Svalbard">
                           Svalbard
                                    </asp:ListItem>
                                    <asp:ListItem Value="Swaziland">
                           Swaziland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sweden">
                           Sweden
                                    </asp:ListItem>
                                    <asp:ListItem Value="Switzerland">
                           Switzerland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Syria">
                           Syria
                                    </asp:ListItem>
                                    <asp:ListItem Value="Taiwan">
                           Taiwan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tajikistan">
                           Tajikistan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tanzania">
                           Tanzania
                                    </asp:ListItem>
                                    <asp:ListItem Value="Thailand">
                           Thailand
                                    </asp:ListItem>
                                    <asp:ListItem Value="Togo">
                           Togo
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tokelau">
                           Tokelau
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tonga">
                           Tonga
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tongareva">
                           Tongareva
                                    </asp:ListItem>
                                    <asp:ListItem Value="Trinidad and Tobago">
                           Trinidad and Tobago
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tromelin Island">
                           Tromelin Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="Trust Territory of the Pacific Islands">
                           Trust Territory of the Pacific Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tuamotu Archipelago">
                           Tuamotu Archipelago
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tunisia">
                           Tunisia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Turkey">
                           Turkey
                                    </asp:ListItem>
                                    <asp:ListItem Value="Turkmenistan">
                           Turkmenistan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Turks and Calcos Islands">
                           Turks and Calcos Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tuvalu">
                           Tuvalu
                                    </asp:ListItem>
                                    <asp:ListItem Value="Uganda">
                           Uganda
                                    </asp:ListItem>
                                    <asp:ListItem Value="Ukraine">
                           Ukraine
                                    </asp:ListItem>
                                    <asp:ListItem Value="United Arab Emirates">
                           United Arab Emirates
                                    </asp:ListItem>
                                    <asp:ListItem Value="Unknown">
                           Unknown
                                    </asp:ListItem>
                                    <asp:ListItem Value="Uruguay">
                           Uruguay
                                    </asp:ListItem>
                                    <asp:ListItem Value="Uzbekistan">
                           Uzbekistan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Vanuatu">
                           Vanuatu
                                    </asp:ListItem>
                                    <asp:ListItem Value="Vatican City">
                           Vatican City
                                    </asp:ListItem>
                                    <asp:ListItem Value="Venezuela">
                           Venezuela
                                    </asp:ListItem>
                                    <asp:ListItem Value="Vietnam">
                           Vietnam
                                    </asp:ListItem>
                                    <asp:ListItem Value="Wales">
                           Wales
                                    </asp:ListItem>
                                    <asp:ListItem Value="Wallis and Futuna">
                           Wallis and Futuna
                                    </asp:ListItem>
                                    <asp:ListItem Value="West Bank">
                           West Bank
                                    </asp:ListItem>
                                    <asp:ListItem Value="West Indies">
                           West Indies
                                    </asp:ListItem>
                                    <asp:ListItem Value="Western Samoa">
                           Western Samoa
                                    </asp:ListItem>
                                    <asp:ListItem Value="Yemen Arab Republic">
                           Yemen Arab Republic
                                    </asp:ListItem>
                                    <asp:ListItem Value="Zaire">
                           Zaire
                                    </asp:ListItem>
                                    <asp:ListItem Value="Zambia">
                           Zambia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Zimbabwe">
                           Zimbabwe
                                    </asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator6" runat="server" ControlToValidate="ddlCountry"
                                    Display="Dynamic" ErrorMessage="<b>Country</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator>
                            </td>
                        </tr>
                    </table>
                    <table style="width: 100%" align="center">
                        <tr>
                            <td style="width: 176px">
                                Contact Phone Number:&nbsp;</td>
                            <td>
                                <asp:TextBox ID="txtReporterContactPhoneNumber" runat="server" Style="width: 361px"
                                    MaxLength="20" />
                            </td>
                        </tr>
                        <tr>
                            <td style="width: 176px">
                                Time Available for Callback:</td>
                            <td>
                                <asp:TextBox ID="txtReporterCallbackTime" runat="server" Style="width: 361px" MaxLength="20" /></td>
                        </tr>
                        <tr>
                            <td style="width: 176px">
                                <sup><span style="color: #ff0000;">*</span></sup>Email Address:</td>
                            <td>
                                <asp:TextBox ID="txtReporterEmailAddress" runat="server" Style="width: 361px" MaxLength="50" />
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator12" runat="server" ControlToValidate="txtReporterEmailAddress"
                                    Display="Dynamic" ErrorMessage="<b>Reporter Email Address</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator>
                                <asp:RegularExpressionValidator ID="RequiredFieldValidator99" runat="server" ControlToValidate="txtReporterEmailAddress"
                                    Display="Dynamic" ErrorMessage="<b>Reporter Email Address</b> format is invalid."
                                    Text="<img src='../Images/error-icon_small.gif'/>" ValidationExpression="\w+([-+.']\w+)*@\w+([-.]\w+)*\.\w+([-.]\w+)*"></asp:RegularExpressionValidator>
                            </td>
                        </tr>
                        <tr>
                            <td style="width: 176px">
                                Relationship to Child:</td>
                            <td>
                                <asp:TextBox ID="txtReporterRelationshipToChild" runat="server" Style="width: 361px"
                                    MaxLength="150" /></td>
                        </tr>
                    </table>
                    <br />
                    <h2>
                        Incident Information</h2>
                    <table style="width: 100%;  text-align:left;">
                        <tr>
                            <td style="width: 191px">
                                <br />
                                <sup><span style="color: #ff0000;">*</span></sup>Approximate Date of Incident:</td>
                            <td class="style5" style="width: 120px">
                                Month
                                <br />
                                <asp:DropDownList ID="ddlIncidentMonth" runat="server" Style="width: 100px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="01">January    (01)</asp:ListItem>
                                    <asp:ListItem Value="02">February   (02)</asp:ListItem>
                                    <asp:ListItem Value="03">March      (03)</asp:ListItem>
                                    <asp:ListItem Value="04">April      (04)</asp:ListItem>
                                    <asp:ListItem Value="05">May        (05)</asp:ListItem>
                                    <asp:ListItem Value="06">June       (06)</asp:ListItem>
                                    <asp:ListItem Value="07">July       (07)</asp:ListItem>
                                    <asp:ListItem Value="08">August     (08)</asp:ListItem>
                                    <asp:ListItem Value="09">Septemeber (09)</asp:ListItem>
                                    <asp:ListItem Value="10">October    (10)</asp:ListItem>
                                    <asp:ListItem Value="11">November   (11)</asp:ListItem>
                                    <asp:ListItem Value="12">December   (12)</asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator14" runat="server" ControlToValidate="ddlIncidentMonth"
                                    Display="Dynamic" ErrorMessage="<b>Incident Month</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator></td>
                            <td class="style5" style="width: 120px">
                                Day
                                <br />
                                <asp:DropDownList ID="ddlIncedentDay" runat="server" Style="width: 100px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="1">1</asp:ListItem>
                                    <asp:ListItem Value="1">2</asp:ListItem>
                                    <asp:ListItem Value="1">3</asp:ListItem>
                                    <asp:ListItem Value="1">4</asp:ListItem>
                                    <asp:ListItem Value="1">5</asp:ListItem>
                                    <asp:ListItem Value="1">6</asp:ListItem>
                                    <asp:ListItem Value="1">7</asp:ListItem>
                                    <asp:ListItem Value="1">8</asp:ListItem>
                                    <asp:ListItem Value="1">9</asp:ListItem>
                                    <asp:ListItem Value="1">10</asp:ListItem>
                                    <asp:ListItem Value="1">11</asp:ListItem>
                                    <asp:ListItem Value="1">12</asp:ListItem>
                                    <asp:ListItem Value="1">14</asp:ListItem>
                                    <asp:ListItem Value="1">15</asp:ListItem>
                                    <asp:ListItem Value="1">16</asp:ListItem>
                                    <asp:ListItem Value="1">17</asp:ListItem>
                                    <asp:ListItem Value="1">18</asp:ListItem>
                                    <asp:ListItem Value="1">19</asp:ListItem>
                                    <asp:ListItem Value="1">20</asp:ListItem>
                                    <asp:ListItem Value="1">21</asp:ListItem>
                                    <asp:ListItem Value="1">22</asp:ListItem>
                                    <asp:ListItem Value="1">23</asp:ListItem>
                                    <asp:ListItem Value="1">24</asp:ListItem>
                                    <asp:ListItem Value="1">25</asp:ListItem>
                                    <asp:ListItem Value="1">26</asp:ListItem>
                                    <asp:ListItem Value="1">27</asp:ListItem>
                                    <asp:ListItem Value="1">28</asp:ListItem>
                                    <asp:ListItem Value="1">29</asp:ListItem>
                                    <asp:ListItem Value="1">30</asp:ListItem>
                                    <asp:ListItem Value="1">31</asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator15" runat="server" ControlToValidate="ddlIncedentDay"
                                    Display="Dynamic" ErrorMessage="<b>Incident Day</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator></td>
                            <td class="style5" style="width: 120px">
                                Year
                                <br />
                                <asp:DropDownList ID="ddlIncidentYear" runat="server" Style="width: 100px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="2014">2014</asp:ListItem>
                                    <asp:ListItem Value="2013">2013</asp:ListItem>
                                    <asp:ListItem Value="2012">2012</asp:ListItem>
                                    <asp:ListItem Value="2011">2011</asp:ListItem>
                                    <asp:ListItem Value="2010">2010</asp:ListItem>
                                    <asp:ListItem Value="2009">2009</asp:ListItem>
                                    <asp:ListItem Value="2008">2008</asp:ListItem>
                                    <asp:ListItem Value="2007">2007</asp:ListItem>
                                    <asp:ListItem Value="2006">2006</asp:ListItem>
                                    <asp:ListItem Value="2005">2005</asp:ListItem>
                                    <asp:ListItem Value="2004">2004</asp:ListItem>
                                    <asp:ListItem Value="2003">2003</asp:ListItem>
                                    <asp:ListItem Value="2002">2002</asp:ListItem>
                                    <asp:ListItem Value="2001">2001</asp:ListItem>
                                    <asp:ListItem Value="2000">2000</asp:ListItem>
                                    <asp:ListItem Value="1999">1989</asp:ListItem>
                                    <asp:ListItem Value="1998">1988</asp:ListItem>
                                    <asp:ListItem Value="1997">1997</asp:ListItem>
                                    <asp:ListItem Value="1996">1996</asp:ListItem>
                                    <asp:ListItem Value="1995">1995</asp:ListItem>
                                    <asp:ListItem Value="1994">1994</asp:ListItem>
                                    <asp:ListItem Value="1993">1993</asp:ListItem>
                                    <asp:ListItem Value="1992">1992</asp:ListItem>
                                    <asp:ListItem Value="1991">1991</asp:ListItem>
                                    <asp:ListItem Value="1990">1990</asp:ListItem>
                                    <asp:ListItem Value="1989">1989</asp:ListItem>
                                    <asp:ListItem Value="1988">1988</asp:ListItem>
                                    <asp:ListItem Value="1987">1987</asp:ListItem>
                                    <asp:ListItem Value="1986">1986</asp:ListItem>
                                    <asp:ListItem Value="1985">1985</asp:ListItem>
                                    <asp:ListItem Value="1984">1984</asp:ListItem>
                                    <asp:ListItem Value="1983">1983</asp:ListItem>
                                    <asp:ListItem Value="1982">1982</asp:ListItem>
                                    <asp:ListItem Value="1981">1981</asp:ListItem>
                                    <asp:ListItem Value="1980">1980</asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator16" runat="server" ControlToValidate="ddlIncidentYear"
                                    Display="Dynamic" ErrorMessage="<b>Incident Year</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator></td>
                            <td class="style6">
                                &nbsp;</td>
                        </tr>
                        <tr>
                            <td style="width: 191px">
                                <br />
                                <sup><span style="color: #ff0000;">*</span></sup>Approximate Time of Incident:</td>
                            <td class="style5" style="width: 120px">
                                Hour
                                <br />
                                <asp:DropDownList ID="ddlIncidentTimeHour" runat="server" Style="width: 100px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="01">01</asp:ListItem>
                                    <asp:ListItem Value="02">02</asp:ListItem>
                                    <asp:ListItem Value="03">03</asp:ListItem>
                                    <asp:ListItem Value="04">04</asp:ListItem>
                                    <asp:ListItem Value="05">05</asp:ListItem>
                                    <asp:ListItem Value="06">06</asp:ListItem>
                                    <asp:ListItem Value="07">07</asp:ListItem>
                                    <asp:ListItem Value="08">08</asp:ListItem>
                                    <asp:ListItem Value="09">09</asp:ListItem>
                                    <asp:ListItem Value="10">10</asp:ListItem>
                                    <asp:ListItem Value="11">11</asp:ListItem>
                                    <asp:ListItem Value="12">12</asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator7" runat="server" ControlToValidate="ddlIncidentTimeHour"
                                    Display="Dynamic" ErrorMessage="<b>Incident Time Hour</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator>
                            </td>
                            <td class="style5" style="width: 120px">
                                Minute
                                <br />
                                <asp:DropDownList ID="ddlIncidentTimeMinte" runat="server" Style="width: 100px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="00">00</asp:ListItem>
                                    <asp:ListItem Value="01">01</asp:ListItem>
                                    <asp:ListItem Value="02">02</asp:ListItem>
                                    <asp:ListItem Value="03">03</asp:ListItem>
                                    <asp:ListItem Value="04">04</asp:ListItem>
                                    <asp:ListItem Value="05">05</asp:ListItem>
                                    <asp:ListItem Value="06">06</asp:ListItem>
                                    <asp:ListItem Value="07">07</asp:ListItem>
                                    <asp:ListItem Value="08">08</asp:ListItem>
                                    <asp:ListItem Value="09">09</asp:ListItem>
                                    <asp:ListItem Value="10">10</asp:ListItem>
                                    <asp:ListItem Value="11">11</asp:ListItem>
                                    <asp:ListItem Value="12">12</asp:ListItem>
                                    <asp:ListItem Value="13">13</asp:ListItem>
                                    <asp:ListItem Value="14">14</asp:ListItem>
                                    <asp:ListItem Value="15">15</asp:ListItem>
                                    <asp:ListItem Value="16">16</asp:ListItem>
                                    <asp:ListItem Value="17">17</asp:ListItem>
                                    <asp:ListItem Value="18">18</asp:ListItem>
                                    <asp:ListItem Value="19">19</asp:ListItem>
                                    <asp:ListItem Value="20">20</asp:ListItem>
                                    <asp:ListItem Value="21">21</asp:ListItem>
                                    <asp:ListItem Value="22">22</asp:ListItem>
                                    <asp:ListItem Value="23">23</asp:ListItem>
                                    <asp:ListItem Value="24">24</asp:ListItem>
                                    <asp:ListItem Value="25">25</asp:ListItem>
                                    <asp:ListItem Value="26">26</asp:ListItem>
                                    <asp:ListItem Value="27">27</asp:ListItem>
                                    <asp:ListItem Value="28">28</asp:ListItem>
                                    <asp:ListItem Value="29">29</asp:ListItem>
                                    <asp:ListItem Value="30">30</asp:ListItem>
                                    <asp:ListItem Value="31">31</asp:ListItem>
                                    <asp:ListItem Value="32">32</asp:ListItem>
                                    <asp:ListItem Value="33">33</asp:ListItem>
                                    <asp:ListItem Value="34">34</asp:ListItem>
                                    <asp:ListItem Value="35">35</asp:ListItem>
                                    <asp:ListItem Value="36">36</asp:ListItem>
                                    <asp:ListItem Value="37">37</asp:ListItem>
                                    <asp:ListItem Value="38">38</asp:ListItem>
                                    <asp:ListItem Value="39">39</asp:ListItem>
                                    <asp:ListItem Value="40">40</asp:ListItem>
                                    <asp:ListItem Value="41">41</asp:ListItem>
                                    <asp:ListItem Value="42">42</asp:ListItem>
                                    <asp:ListItem Value="43">43</asp:ListItem>
                                    <asp:ListItem Value="44">44</asp:ListItem>
                                    <asp:ListItem Value="45">45</asp:ListItem>
                                    <asp:ListItem Value="46">46</asp:ListItem>
                                    <asp:ListItem Value="47">47</asp:ListItem>
                                    <asp:ListItem Value="48">48</asp:ListItem>
                                    <asp:ListItem Value="49">49</asp:ListItem>
                                    <asp:ListItem Value="50">50</asp:ListItem>
                                    <asp:ListItem Value="51">51</asp:ListItem>
                                    <asp:ListItem Value="52">52</asp:ListItem>
                                    <asp:ListItem Value="53">53</asp:ListItem>
                                    <asp:ListItem Value="54">54</asp:ListItem>
                                    <asp:ListItem Value="55">55</asp:ListItem>
                                    <asp:ListItem Value="56">56</asp:ListItem>
                                    <asp:ListItem Value="57">57</asp:ListItem>
                                    <asp:ListItem Value="58">58</asp:ListItem>
                                    <asp:ListItem Value="59">59</asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator8" runat="server" ControlToValidate="ddlIncidentTimeMinte"
                                    Display="Dynamic" ErrorMessage="<b>Incident Time Minute</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator>
                            </td>
                            <td class="style5" style="width: 120px">
                                AM/PM
                                <br />
                                <asp:DropDownList ID="ddlIncidentTimeOfDay" runat="server" Style="width: 100px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="AM">AM</asp:ListItem>
                                    <asp:ListItem Value="PM">PM</asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator9" runat="server" ControlToValidate="ddlIncidentTimeOfDay"
                                    Display="Dynamic" ErrorMessage="<b>Incident Time Of Day</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator>
                            </td>
                            <td class="style6">
                                &nbsp;</td>
                        </tr>
                    </table>
                    <table style="width: 100%;  text-align:left;">
                        <tr>
                            <td style="width: 191px">
                                <sup><span style="color: #ff0000;">*</span></sup>Time Zone:</td>
                            <td>
                                <asp:DropDownList ID="ddlIncidentTimeZone" runat="server" Style="width: 361px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="Eastern Daylight Time (UTC -4)">Eastern Daylight Time (UTC -4)</asp:ListItem>
                                    <asp:ListItem Value="Eastern Standard Time (UTC -5)">Eastern Standard Time (UTC -5)</asp:ListItem>
                                    <asp:ListItem Value="Central Daylight Time (UTC -5)">Central Daylight Time (UTC -5)</asp:ListItem>
                                    <asp:ListItem Value="Central Standard Time (UTC -6)">Central Standard Time (UTC -6)</asp:ListItem>
                                    <asp:ListItem Value="Mountain Daylight Time (UTC -6)">Mountain Daylight Time (UTC -6)</asp:ListItem>
                                    <asp:ListItem Value="Mountain Standard Time (UTC -7)">Mountain Standard Time (UTC -7)</asp:ListItem>
                                    <asp:ListItem Value="Pacific Daylight Time (UTC -7)">Pacific Daylight Time (UTC -7)</asp:ListItem>
                                    <asp:ListItem Value="Pacific Standard Time (UTC -8)">Pacific Standard Time (UTC -8)</asp:ListItem>
                                    <asp:ListItem Value="Alaska Daylight Time (UTC -8)">Alaska Daylight Time (UTC -8)</asp:ListItem>
                                    <asp:ListItem Value="Alaska Standard Time (UTC -9)">Alaska Standard Time (UTC -9)</asp:ListItem>
                                    <asp:ListItem Value="Hawaii-Aleutian Daylight Time (UTC -9)">Hawaii-Aleutian Daylight Time (UTC -9)</asp:ListItem>
                                    <asp:ListItem Value="Hawaii-Aleutian Standard Time (UTC -10)">Hawaii-Aleutian Standard Time (UTC -10)</asp:ListItem>
                                    <asp:ListItem Value="Atlantic Daylight Time (UTC -3)">Atlantic Daylight Time (UTC -3)</asp:ListItem>
                                    <asp:ListItem Value="Atlantic Standard Time (UTC -4)">Atlantic Standard Time (UTC -4)</asp:ListItem>
                                    <asp:ListItem Value="Heure Avancée de l'Atlantique (UTC -3)">Heure Avancée de l'Atlantique (UTC -3)</asp:ListItem>
                                    <asp:ListItem Value="Heure Avancée du Centre (UTC -5)">Heure Avancée du Centre (UTC -5)</asp:ListItem>
                                    <asp:ListItem Value="Heure Avancée de l'Est (UTC -4)">Heure Avancée de l'Est (UTC -4)</asp:ListItem>
                                    <asp:ListItem Value="Heure Avancée du Pacifique (UTC -7)">Heure Avancée du Pacifique (UTC -7)</asp:ListItem>
                                    <asp:ListItem Value="Heure Avancée des Rocheuses (UTC -6)">Heure Avancée des Rocheuses (UTC -6)</asp:ListItem>
                                    <asp:ListItem Value="Heure Avancée de Terre-Neuve (UTC -2:30)">Heure Avancée de Terre-Neuve (UTC -2:30)</asp:ListItem>
                                    <asp:ListItem Value="Heure Avancée du Yukon (UTC -8)">Heure Avancée du Yukon (UTC -8)</asp:ListItem>
                                    <asp:ListItem Value="Heure Normale de l'Atlantique (UTC -4)">Heure Normale de l'Atlantique (UTC -4)</asp:ListItem>
                                    <asp:ListItem Value="Heure Normale du Centre (UTC -6)">Heure Normale du Centre (UTC -6)</asp:ListItem>
                                    <asp:ListItem Value="Heure Normale de l'Est (UTC -5)">Heure Normale de l'Est (UTC -5)</asp:ListItem>
                                    <asp:ListItem Value="Heure Normale du Pacifique (UTC -8)">Heure Normale du Pacifique (UTC -8)</asp:ListItem>
                                    <asp:ListItem Value="Heure Normale des Rocheuses (UTC -7)">Heure Normale des Rocheuses (UTC -7)</asp:ListItem>
                                    <asp:ListItem Value="Heure Normale de Terre-Neuve (UTC -3:30)">Heure Normale de Terre-Neuve (UTC -3:30)</asp:ListItem>
                                    <asp:ListItem Value="Heure Normale du Yukon (UTC -9)">Heure Normale du Yukon (UTC -9)</asp:ListItem>
                                    <asp:ListItem Value="Newfoundland Daylight Time (UTC -2:30)">Newfoundland Daylight Time (UTC -2:30)</asp:ListItem>
                                    <asp:ListItem Value="Newfoundland Standard Time (UTC -3:30)">Newfoundland Standard Time (UTC -3:30)</asp:ListItem>
                                    <asp:ListItem Value="Australian Central Daylight Time (UTC +10:30)">Australian Central Daylight Time (UTC +10:30)</asp:ListItem>
                                    <asp:ListItem Value="Australian Central Standard Time (UTC +9:30)">Australian Central Standard Time (UTC +9:30)</asp:ListItem>
                                    <asp:ListItem Value="Australian Eastern Daylight or Summer Time (UTC +11)">Australian Eastern Daylight or Summer Time (UTC +11)</asp:ListItem>
                                    <asp:ListItem Value="Australian Eastern Standard Time (UTC +10)">Australian Eastern Standard Time (UTC +10)</asp:ListItem>
                                    <asp:ListItem Value="Australian Western Daylight Time (UTC +9)">Australian Western Daylight Time (UTC +9)</asp:ListItem>
                                    <asp:ListItem Value="Australian Western Standard Time (UTC +8)">Australian Western Standard Time (UTC +8)</asp:ListItem>
                                    <asp:ListItem Value="Central Daylight Time (UTC +10:30)">Central Daylight Time (UTC +10:30)</asp:ListItem>
                                    <asp:ListItem Value="Central Summer Time (UTC +10:30)">Central Summer Time (UTC +10:30)</asp:ListItem>
                                    <asp:ListItem Value="Central Standard Time (UTC +9:30)">Central Standard Time (UTC +9:30)</asp:ListItem>
                                    <asp:ListItem Value="Christmas Island Time (UTC +7 )">Christmas Island Time (UTC +7 )</asp:ListItem>
                                    <asp:ListItem Value="Eastern Daylight Time (UTC +11)">Eastern Daylight Time (UTC +11)</asp:ListItem>
                                    <asp:ListItem Value="Eastern Summer Time (UTC +11)">Eastern Summer Time (UTC +11)</asp:ListItem>
                                    <asp:ListItem Value="Eastern Standard Time (UTC +10)">Eastern Standard Time (UTC +10)</asp:ListItem>
                                    <asp:ListItem Value="Norfolk (Island) Time (UTC +11:30)">Norfolk (Island) Time (UTC +11:30)</asp:ListItem>
                                    <asp:ListItem Value="Western Daylight Time (UTC +9)">Western Daylight Time (UTC +9)</asp:ListItem>
                                    <asp:ListItem Value="Western Summer Time (UTC +9)">Western Summer Time (UTC +9)</asp:ListItem>
                                    <asp:ListItem Value="Western Standard Time (UTC +8)">Western Standard Time (UTC +8)</asp:ListItem>
                                    <asp:ListItem Value="British Summer Time (UTC +1)">British Summer Time (UTC +1)</asp:ListItem>
                                    <asp:ListItem Value="Central European Daylight Time (UTC +2)">Central European Daylight Time (UTC +2)</asp:ListItem>
                                    <asp:ListItem Value="Central European Summer Time (UTC +2)">Central European Summer Time (UTC +2)</asp:ListItem>
                                    <asp:ListItem Value="Central European Time (UTC +1)">Central European Time (UTC +1)</asp:ListItem>
                                    <asp:ListItem Value="Eastern European Daylight Time (UTC +3)">Eastern European Daylight Time (UTC +3)</asp:ListItem>
                                    <asp:ListItem Value="Eastern European Summer Time (UTC +3)">Eastern European Summer Time (UTC +3)</asp:ListItem>
                                    <asp:ListItem Value="Eastern European Time (UTC +2)">Eastern European Time (UTC +2)</asp:ListItem>
                                    <asp:ListItem Value="Greenwich Mean Time (UTC)">Greenwich Mean Time (UTC)</asp:ListItem>
                                    <asp:ListItem Value="Irish Summer Time (UTC +1)">Irish Summer Time (UTC +1)</asp:ListItem>
                                    <asp:ListItem Value="Mitteleuroäische Sommerzeit (UTC +2)">Mitteleuroäische Sommerzeit (UTC +2)</asp:ListItem>
                                    <asp:ListItem Value="Mitteleuropäische Zeit (UTC +1)">Mitteleuropäische Zeit (UTC +1)</asp:ListItem>
                                    <asp:ListItem Value="Moscow Daylight Time (UTC +4)">Moscow Daylight Time (UTC +4)</asp:ListItem>
                                    <asp:ListItem Value="Moscow Standard Time (UTC +3)">Moscow Standard Time (UTC +3)</asp:ListItem>
                                    <asp:ListItem Value="Coordinated Universal Time (UTC)">Coordinated Universal Time (UTC)</asp:ListItem>
                                    <asp:ListItem Value="Western European Daylight Time (UTC +1)">Western European Daylight Time (UTC +1)</asp:ListItem>
                                    <asp:ListItem Value="Western European Summer Time (UTC +1)">Western European Summer Time (UTC +1)</asp:ListItem>
                                    <asp:ListItem Value="Western European Time (UTC)">Western European Time (UTC)</asp:ListItem>
                                    <asp:ListItem Value="AKDT">
        	            Alaska Daylight Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="AKST">
     	                Alaska Standard Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="AST">
     	                Atlantic
                                    </asp:ListItem>
                                    <asp:ListItem Value="CDT">
                        Central Daylight Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="CST">
                        Central Standard Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="CET">
                        Europe/Central
                                    </asp:ListItem>
                                    <asp:ListItem Value="EDT">
       		            Eastern Daylight Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="EET">
      		            Europe/Eastern
                                    </asp:ListItem>
                                    <asp:ListItem Value="EST">
     		            Eastern Standard Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="GMT">
                        Britain
                                    </asp:ListItem>
                                    <asp:ListItem Value="HADT">
      		            Hawaii-Aleutian Daylight Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="HAST">
      		            Hawaii-Aleutian Standard Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="IST">
                        Israel
                                    </asp:ListItem>
                                    <asp:ListItem Value="JST">
     		            Japan
                                    </asp:ListItem>
                                    <asp:ListItem Value="MDT">
     		            Mountain Daylight Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="MET">
     	                Europe/Middle
                                    </asp:ListItem>
                                    <asp:ListItem Value="MST">
      		            Mountain Standard Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="NST">
      		            Newfoundland
                                    </asp:ListItem>
                                    <asp:ListItem Value="NZS">
                        New Zealand
                                    </asp:ListItem>
                                    <asp:ListItem Value="PDT">
                        Pacific Daylight Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="PST">
     	                Pacific Standard Time
                                    </asp:ListItem>
                                    <asp:ListItem Value="SST">
       	                Singapore
                                    </asp:ListItem>
                                    <asp:ListItem Value="WET">
     	                Europe/Western
                                    </asp:ListItem>
                                    <asp:ListItem Value="WST">
     	                Australia/West
                                    </asp:ListItem>
                                    <asp:ListItem Value="YST">
     	                Yukon
                                    </asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator10" runat="server" ControlToValidate="ddlIncidentTimeZone"
                                    Display="Dynamic" ErrorMessage="<b>Incident Time Zone</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator>
                            </td>
                        </tr>
                        <tr>
                            <td style="width: 190px">
                                <sup><span style="color: #ff0000;">*</span></sup>Type of Incident:</td>
                            <td>
                                <asp:DropDownList ID="ddlIncidentType" runat="server" Style="width: 361px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="Child_Pornography">Child Pornography(possession, manufacture, and distribution)</asp:ListItem>
                                    <asp:ListItem Value="Online_Enticement">Online Enticement of Children for Sexual Acts</asp:ListItem>
                                    <asp:ListItem Value="Obscene_Material">Unsolicited Obscene Material Sent to a Child</asp:ListItem>
                                    <asp:ListItem Value="Misleading_Domain">Misleading Domain Name</asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator11" runat="server" ControlToValidate="ddlIncidentType"
                                    Display="Dynamic" ErrorMessage="<b>Incident Type</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator>
                            </td>
                        </tr>
                    </table>
                    <table style="width: 100%;  text-align:left;">
                        <tr>
                            <td style="width: 130px;" rowspan="3">
                                Location of Incident:
                            </td>
                            <td style="width: 57px; height: 23px;">
                                City:</td>
                            <td style="height: 23px">
                                <asp:TextBox ID="txtIncidentCity" runat="server" Style="width: 355px" MaxLength="100" />
                            </td>
                        </tr>
                        <tr>
                            <td style="width: 57px; height: 23px;">
                                State:</td>
                            <td style="height: 23px">
                                <asp:DropDownList ID="ddlIncidentLocationState" runat="server" Style="width: 361px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="AL">Alabama</asp:ListItem>
                                    <asp:ListItem Value="AK">Alaska</asp:ListItem>
                                    <asp:ListItem Value="AZ">Arizona</asp:ListItem>
                                    <asp:ListItem Value="AR">Arkansas</asp:ListItem>
                                    <asp:ListItem Value="CA">California</asp:ListItem>
                                    <asp:ListItem Value="CO">Colorado</asp:ListItem>
                                    <asp:ListItem Value="CT">Connecticut</asp:ListItem>
                                    <asp:ListItem Value="DE">Delaware</asp:ListItem>
                                    <asp:ListItem Value="DC">District of Columbia</asp:ListItem>
                                    <asp:ListItem Value="FL">Florida</asp:ListItem>
                                    <asp:ListItem Value="GA">Georgia</asp:ListItem>
                                    <asp:ListItem Value="GU">Guam</asp:ListItem>
                                    <asp:ListItem Value="HI">Hawaii</asp:ListItem>
                                    <asp:ListItem Value="ID">Idaho</asp:ListItem>
                                    <asp:ListItem Value="IL">Illinois</asp:ListItem>
                                    <asp:ListItem Value="IN">Indiana</asp:ListItem>
                                    <asp:ListItem Value="IA">Iowa</asp:ListItem>
                                    <asp:ListItem Value="KS">Kansas</asp:ListItem>
                                    <asp:ListItem Value="KY">Kentucky</asp:ListItem>
                                    <asp:ListItem Value="LA">Louisiana</asp:ListItem>
                                    <asp:ListItem Value="ME">Maine</asp:ListItem>
                                    <asp:ListItem Value="MD">Maryland</asp:ListItem>
                                    <asp:ListItem Value="MA">Massachusetts</asp:ListItem>
                                    <asp:ListItem Value="MI">Michigan</asp:ListItem>
                                    <asp:ListItem Value="MN">Minnesota</asp:ListItem>
                                    <asp:ListItem Value="MS">Mississippi</asp:ListItem>
                                    <asp:ListItem Value="MO">Missouri</asp:ListItem>
                                    <asp:ListItem Value="MT">Montana</asp:ListItem>
                                    <asp:ListItem Value="NE">Nebraska</asp:ListItem>
                                    <asp:ListItem Value="NV">Nevada</asp:ListItem>
                                    <asp:ListItem Value="NH">New Hampshire</asp:ListItem>
                                    <asp:ListItem Value="NJ">New Jersey</asp:ListItem>
                                    <asp:ListItem Value="NM">New Mexico</asp:ListItem>
                                    <asp:ListItem Value="NY">New York</asp:ListItem>
                                    <asp:ListItem Value="NC">North Carolina</asp:ListItem>
                                    <asp:ListItem Value="ND">North Dakota</asp:ListItem>
                                    <asp:ListItem Value="OH">Ohio</asp:ListItem>
                                    <asp:ListItem Value="OK">Oklahoma</asp:ListItem>
                                    <asp:ListItem Value="OR">Oregon</asp:ListItem>
                                    <asp:ListItem Value="PA">Pennsylvania</asp:ListItem>
                                    <asp:ListItem Value="PR">Puerto Rico</asp:ListItem>
                                    <asp:ListItem Value="RI">Rhode Island</asp:ListItem>
                                    <asp:ListItem Value="SC">South Carolina</asp:ListItem>
                                    <asp:ListItem Value="SD">South Dakota</asp:ListItem>
                                    <asp:ListItem Value="TN">Tennessee</asp:ListItem>
                                    <asp:ListItem Value="TX">Texas</asp:ListItem>
                                    <asp:ListItem Value="UT">Utah</asp:ListItem>
                                    <asp:ListItem Value="VT">Vermont</asp:ListItem>
                                    <asp:ListItem Value="VA">Virginia</asp:ListItem>
                                    <asp:ListItem Value="VI">Virgin Islands</asp:ListItem>
                                    <asp:ListItem Value="WA">Washington</asp:ListItem>
                                    <asp:ListItem Value="WV">West Virginia</asp:ListItem>
                                    <asp:ListItem Value="WI">Wisconsin</asp:ListItem>
                                    <asp:ListItem Value="WY">Wyoming</asp:ListItem>
                                </asp:DropDownList>
                            </td>
                        </tr>
                        <tr>
                            <td style="width: 57px; height: 23px;">
                                Country:
                            </td>
                            <td style="height: 23px">
                                <asp:DropDownList ID="ddlIncidentLocationCountry" runat="server" Style="width: 361px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="United States">
                           United States
                                    </asp:ListItem>
                                    <asp:ListItem Value="Afghanistan">
                           Afghanistan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Albania">
                           Albania
                                    </asp:ListItem>
                                    <asp:ListItem Value="Algeria">
                           Algeria
                                    </asp:ListItem>
                                    <asp:ListItem Value="All others">
                           All others
                                    </asp:ListItem>
                                    <asp:ListItem Value="Andorra">
                           Andorra
                                    </asp:ListItem>
                                    <asp:ListItem Value="Angola">
                           Angola
                                    </asp:ListItem>
                                    <asp:ListItem Value="Anguilla">
                           Anguilla
                                    </asp:ListItem>
                                    <asp:ListItem Value="Antigua and Barbuda">
                           Antigua and Barbuda
                                    </asp:ListItem>
                                    <asp:ListItem Value="Argentina">
                           Argentina
                                    </asp:ListItem>
                                    <asp:ListItem Value="Armenia">
                           Armenia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Aruba">
                           Aruba
                                    </asp:ListItem>
                                    <asp:ListItem Value="Ashmore and Cartier Islands">
                           Ashmore and Cartier Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Australia">
                           Australia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Austria">
                           Austria
                                    </asp:ListItem>
                                    <asp:ListItem Value="Azerbaijan">
                           Azerbaijan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Azores Islands">
                           Azores Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bahamas">
                           Bahamas
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bahrain/Bahrein">
                           Bahrain/Bahrein
                                    </asp:ListItem>
                                    <asp:ListItem Value="Balearic Islands">
                           Balearic Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bangladesh">
                           Bangladesh
                                    </asp:ListItem>
                                    <asp:ListItem Value="Barbados">
                           Barbados
                                    </asp:ListItem>
                                    <asp:ListItem Value="Barbuda and Antigua">
                           Barbuda and Antigua
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bassas Da India">
                           Bassas Da India
                                    </asp:ListItem>
                                    <asp:ListItem Value="Belgium">
                           Belgium
                                    </asp:ListItem>
                                    <asp:ListItem Value="Belize">
                           Belize
                                    </asp:ListItem>
                                    <asp:ListItem Value="Benin">
                           Benin
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bermuda">
                           Bermuda
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bhutan">
                           Bhutan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bolivia">
                           Bolivia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bonaire">
                           Bonaire
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bosnia and Hercegovenia">
                           Bosnia and Hercegovenia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Botswana">
                           Botswana
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bouvet Island">
                           Bouvet Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="Brazil">
                           Brazil
                                    </asp:ListItem>
                                    <asp:ListItem Value="British Indian Ocean Territory">
                           British Indian Ocean Territory
                                    </asp:ListItem>
                                    <asp:ListItem Value="British Virgin Islands">
                           British Virgin Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Brunei">
                           Brunei
                                    </asp:ListItem>
                                    <asp:ListItem Value="Bulgaria">
                           Bulgaria
                                    </asp:ListItem>
                                    <asp:ListItem Value="Burkina Faso">
                           Burkina Faso
                                    </asp:ListItem>
                                    <asp:ListItem Value="Burma">
                           Burma
                                    </asp:ListItem>
                                    <asp:ListItem Value="Burundi">
                           Burundi
                                    </asp:ListItem>
                                    <asp:ListItem Value="Byelarus">
                           Byelarus
                                    </asp:ListItem>
                                    <asp:ListItem Value="Cambodia">
                           Cambodia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Cameroon">
                           Cameroon
                                    </asp:ListItem>
                                    <asp:ListItem Value="Canada">
                           Canada
                                    </asp:ListItem>
                                    <asp:ListItem Value="Canary Islands">
                           Canary Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Cape Verde Islands">
                           Cape Verde Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Cayman Islands">
                           Cayman Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Central African Republic">
                           Central African Republic
                                    </asp:ListItem>
                                    <asp:ListItem Value="Chad">
                           Chad
                                    </asp:ListItem>
                                    <asp:ListItem Value="Chile">
                           Chile
                                    </asp:ListItem>
                                    <asp:ListItem Value="Christmas Island">
                           Christmas Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="Clipperton Island">
                           Clipperton Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="Cocos (Keeling) Islands">
                           Cocos (Keeling) Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Colombia">
                           Colombia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Comoros">
                           Comoros
                                    </asp:ListItem>
                                    <asp:ListItem Value="Cook Islands">
                           Cook Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Coral Sea Islands">
                           Coral Sea Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Costa Rica">
                           Costa Rica
                                    </asp:ListItem>
                                    <asp:ListItem Value="Cote d'Ivoire (Ivory Coast)">
                           Cote d'Ivoire (Ivory Coast)
                                    </asp:ListItem>
                                    <asp:ListItem Value="Croatia">
                           Croatia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Cuba">
                           Cuba
                                    </asp:ListItem>
                                    <asp:ListItem Value="Curacao">
                           Curacao
                                    </asp:ListItem>
                                    <asp:ListItem Value="Cyprus">
                           Cyprus
                                    </asp:ListItem>
                                    <asp:ListItem Value="Czech Republic">
                           Czech Republic
                                    </asp:ListItem>
                                    <asp:ListItem Value="Denmark">
                           Denmark
                                    </asp:ListItem>
                                    <asp:ListItem Value="Djibouti">
                           Djibouti
                                    </asp:ListItem>
                                    <asp:ListItem Value="Dominica">
                           Dominica
                                    </asp:ListItem>
                                    <asp:ListItem Value="Dominican Republic">
                           Dominican Republic
                                    </asp:ListItem>
                                    <asp:ListItem Value="Ecuador">
                           Ecuador
                                    </asp:ListItem>
                                    <asp:ListItem Value="Egypt">
                           Egypt
                                    </asp:ListItem>
                                    <asp:ListItem Value="El Salvador">
                           El Salvador
                                    </asp:ListItem>
                                    <asp:ListItem Value="England">
                           England
                                    </asp:ListItem>
                                    <asp:ListItem Value="Equatorial Guinea">
                           Equatorial Guinea
                                    </asp:ListItem>
                                    <asp:ListItem Value="Eretria">
                           Eretria
                                    </asp:ListItem>
                                    <asp:ListItem Value="Estonia">
                           Estonia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Ethiopia">
                           Ethiopia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Europa Island">
                           Europa Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="Falkland Islands">
                           Falkland Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Faroe Islands">
                           Faroe Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Federated States of Micronesia">
                           Federated States of Micronesia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Fiji">
                           Fiji
                                    </asp:ListItem>
                                    <asp:ListItem Value="Finland">
                           Finland
                                    </asp:ListItem>
                                    <asp:ListItem Value="France">
                           France
                                    </asp:ListItem>
                                    <asp:ListItem Value="French Guiana">
                           French Guiana
                                    </asp:ListItem>
                                    <asp:ListItem Value="French Polynesia">
                           French Polynesia
                                    </asp:ListItem>
                                    <asp:ListItem Value="French Southern and Antartic Lands">
                           French Southern and Antartic Lands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Gabon">
                           Gabon
                                    </asp:ListItem>
                                    <asp:ListItem Value="Gambia, The">
                           Gambia, The
                                    </asp:ListItem>
                                    <asp:ListItem Value="Gaza">
                           Gaza
                                    </asp:ListItem>
                                    <asp:ListItem Value="Georgia">
                           Georgia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Germany">
                           Germany
                                    </asp:ListItem>
                                    <asp:ListItem Value="Ghana">
                           Ghana
                                    </asp:ListItem>
                                    <asp:ListItem Value="Gibraltar">
                           Gibraltar
                                    </asp:ListItem>
                                    <asp:ListItem Value="Glorioso Islands">
                           Glorioso Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Greece">
                           Greece
                                    </asp:ListItem>
                                    <asp:ListItem Value="Greenland">
                           Greenland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Grenada">
                           Grenada
                                    </asp:ListItem>
                                    <asp:ListItem Value="Guadeloupe">
                           Guadeloupe
                                    </asp:ListItem>
                                    <asp:ListItem Value="Guatemala">
                           Guatemala
                                    </asp:ListItem>
                                    <asp:ListItem Value="Guernsey">
                           Guernsey
                                    </asp:ListItem>
                                    <asp:ListItem Value="Guiana, French">
                           Guiana, French
                                    </asp:ListItem>
                                    <asp:ListItem Value="Guinea">
                           Guinea
                                    </asp:ListItem>
                                    <asp:ListItem Value="Guinea-Bissau">
                           Guinea-Bissau
                                    </asp:ListItem>
                                    <asp:ListItem Value="Guyana">
                           Guyana
                                    </asp:ListItem>
                                    <asp:ListItem Value="Haiti">
                           Haiti
                                    </asp:ListItem>
                                    <asp:ListItem Value="Heard Island and McDonald Island">
                           Heard Island and McDonald Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="Honduras">
                           Honduras
                                    </asp:ListItem>
                                    <asp:ListItem Value="Hong Kong">
                           Hong Kong
                                    </asp:ListItem>
                                    <asp:ListItem Value="Hungary">
                           Hungary
                                    </asp:ListItem>
                                    <asp:ListItem Value="Iceland">
                           Iceland
                                    </asp:ListItem>
                                    <asp:ListItem Value="India">
                           India
                                    </asp:ListItem>
                                    <asp:ListItem Value="Indonesia">
                           Indonesia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Iran">
                           Iran
                                    </asp:ListItem>
                                    <asp:ListItem Value="Iraq">
                           Iraq
                                    </asp:ListItem>
                                    <asp:ListItem Value="Ireland">
                           Ireland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Isle of Man">
                           Isle of Man
                                    </asp:ListItem>
                                    <asp:ListItem Value="Israel">
                           Israel
                                    </asp:ListItem>
                                    <asp:ListItem Value="Italy">
                           Italy
                                    </asp:ListItem>
                                    <asp:ListItem Value="Jamaica">
                           Jamaica
                                    </asp:ListItem>
                                    <asp:ListItem Value="Jan Mayen">
                           Jan Mayen
                                    </asp:ListItem>
                                    <asp:ListItem Value="Japan">
                           Japan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Jersey">
                           Jersey
                                    </asp:ListItem>
                                    <asp:ListItem Value="Jordan">
                           Jordan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Juan de Nova Island">
                           Juan de Nova Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="Kazakhstan">
                           Kazakhstan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Kenya">
                           Kenya
                                    </asp:ListItem>
                                    <asp:ListItem Value="Kiribati">
                           Kiribati
                                    </asp:ListItem>
                                    <asp:ListItem Value="Kuwait">
                           Kuwait
                                    </asp:ListItem>
                                    <asp:ListItem Value="Kyrgyzstan">
                           Kyrgyzstan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Labrador">
                           Labrador
                                    </asp:ListItem>
                                    <asp:ListItem Value="Laos">
                           Laos
                                    </asp:ListItem>
                                    <asp:ListItem Value="Lebanon">
                           Lebanon
                                    </asp:ListItem>
                                    <asp:ListItem Value="Lesotho">
                           Lesotho
                                    </asp:ListItem>
                                    <asp:ListItem Value="Liberia">
                           Liberia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Libya">
                           Libya
                                    </asp:ListItem>
                                    <asp:ListItem Value="Liechtenstein">
                           Liechtenstein
                                    </asp:ListItem>
                                    <asp:ListItem Value="Lithuania">
                           Lithuania
                                    </asp:ListItem>
                                    <asp:ListItem Value="Luxembourg">
                           Luxembourg
                                    </asp:ListItem>
                                    <asp:ListItem Value="Macau">
                           Macau
                                    </asp:ListItem>
                                    <asp:ListItem Value="Macedonia">
                           Macedonia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Madagascar">
                           Madagascar
                                    </asp:ListItem>
                                    <asp:ListItem Value="Madeira Islands">
                           Madeira Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Malagasy Republic">
                           Malagasy Republic
                                    </asp:ListItem>
                                    <asp:ListItem Value="Malawi">
                           Malawi
                                    </asp:ListItem>
                                    <asp:ListItem Value="Malaysia">
                           Malaysia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Maldives">
                           Maldives
                                    </asp:ListItem>
                                    <asp:ListItem Value="Mali">
                           Mali
                                    </asp:ListItem>
                                    <asp:ListItem Value="Malta">
                           Malta
                                    </asp:ListItem>
                                    <asp:ListItem Value="Manahiki Island">
                           Manahiki Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="Martinique">
                           Martinique
                                    </asp:ListItem>
                                    <asp:ListItem Value="Mauritania">
                           Mauritania
                                    </asp:ListItem>
                                    <asp:ListItem Value="Mauritius">
                           Mauritius
                                    </asp:ListItem>
                                    <asp:ListItem Value="Mayotte">
                           Mayotte
                                    </asp:ListItem>
                                    <asp:ListItem Value="McDonald Island and Heard Island">
                           McDonald Island and Heard Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="Mexico">
                           Mexico
                                    </asp:ListItem>
                                    <asp:ListItem Value="Moldova">
                           Moldova
                                    </asp:ListItem>
                                    <asp:ListItem Value="Monaco">
                           Monaco
                                    </asp:ListItem>
                                    <asp:ListItem Value="Mongolia">
                           Mongolia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Montserrat">
                           Montserrat
                                    </asp:ListItem>
                                    <asp:ListItem Value="Morocco">
                           Morocco
                                    </asp:ListItem>
                                    <asp:ListItem Value="Mozambique">
                           Mozambique
                                    </asp:ListItem>
                                    <asp:ListItem Value="Namibia">
                           Namibia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nauru">
                           Nauru
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nepal">
                           Nepal
                                    </asp:ListItem>
                                    <asp:ListItem Value="Netherlands">
                           Netherlands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Netherlands Antilles">
                           Netherlands Antilles
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nevis">
                           Nevis
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nevis and Saint Christopher">
                           Nevis and Saint Christopher
                                    </asp:ListItem>
                                    <asp:ListItem Value="New Caledonia">
                           New Caledonia
                                    </asp:ListItem>
                                    <asp:ListItem Value="New Zealand">
                           New Zealand
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nicaragua">
                           Nicaragua
                                    </asp:ListItem>
                                    <asp:ListItem Value="Niger">
                           Niger
                                    </asp:ListItem>
                                    <asp:ListItem Value="Nigeria">
                           Nigeria
                                    </asp:ListItem>
                                    <asp:ListItem Value="Niue">
                           Niue
                                    </asp:ListItem>
                                    <asp:ListItem Value="Norfolk Island">
                           Norfolk Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="North Korea">
                           North Korea
                                    </asp:ListItem>
                                    <asp:ListItem Value="Northern Ireland">
                           Northern Ireland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Norway">
                           Norway
                                    </asp:ListItem>
                                    <asp:ListItem Value="Okinawa">
                           Okinawa
                                    </asp:ListItem>
                                    <asp:ListItem Value="Oman">
                           Oman
                                    </asp:ListItem>
                                    <asp:ListItem Value="Pakistan">
                           Pakistan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Palau, Republic of">
                           Palau, Republic of
                                    </asp:ListItem>
                                    <asp:ListItem Value="Panama">
                           Panama
                                    </asp:ListItem>
                                    <asp:ListItem Value="Papua New Guinea">
                           Papua New Guinea
                                    </asp:ListItem>
                                    <asp:ListItem Value="Paraguay">
                           Paraguay
                                    </asp:ListItem>
                                    <asp:ListItem Value="Parcel Islands">
                           Parcel Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="People's Republic of China">
                           People's Republic of China
                                    </asp:ListItem>
                                    <asp:ListItem Value="Peru">
                           Peru
                                    </asp:ListItem>
                                    <asp:ListItem Value="Philippines">
                           Philippines
                                    </asp:ListItem>
                                    <asp:ListItem Value="Pitcairn, Henderson, Ducie, and Oeno">
                           Pitcairn, Henderson, Ducie, and Oeno
                                    </asp:ListItem>
                                    <asp:ListItem Value="Poland">
                           Poland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Polynesia, French">
                           Polynesia, French
                                    </asp:ListItem>
                                    <asp:ListItem Value="Portugal">
                           Portugal
                                    </asp:ListItem>
                                    <asp:ListItem Value="Qatar">
                           Qatar
                                    </asp:ListItem>
                                    <asp:ListItem Value="Republic of Congo,">
                           Republic of Congo,
                                    </asp:ListItem>
                                    <asp:ListItem Value="Reunion">
                           Reunion
                                    </asp:ListItem>
                                    <asp:ListItem Value="Romania/Rumania">
                           Romania/Rumania
                                    </asp:ListItem>
                                    <asp:ListItem Value="Russia">
                           Russia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Russian Federation">
                           Russian Federation
                                    </asp:ListItem>
                                    <asp:ListItem Value="Rwanda">
                           Rwanda
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Christopher">
                           Saint Christopher
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Helena">
                           Saint Helena
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Kitts">
                           Saint Kitts
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Lucia">
                           Saint Lucia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Pierre and Miquelon">
                           Saint Pierre and Miquelon
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saint Vincent and the Grenadines">
                           Saint Vincent and the Grenadines
                                    </asp:ListItem>
                                    <asp:ListItem Value="San Marino">
                           San Marino
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sao Tome and Principe">
                           Sao Tome and Principe
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sardinia">
                           Sardinia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Saudi Arabia">
                           Saudi Arabia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Scotland">
                           Scotland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Senegal">
                           Senegal
                                    </asp:ListItem>
                                    <asp:ListItem Value="Seychelles">
                           Seychelles
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sicily">
                           Sicily
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sierre Leone">
                           Sierre Leone
                                    </asp:ListItem>
                                    <asp:ListItem Value="Singapore">
                           Singapore
                                    </asp:ListItem>
                                    <asp:ListItem Value="Slovakia">
                           Slovakia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Slovenia">
                           Slovenia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Solomon Islands">
                           Solomon Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Somalia">
                           Somalia
                                    </asp:ListItem>
                                    <asp:ListItem Value="South Africa">
                           South Africa
                                    </asp:ListItem>
                                    <asp:ListItem Value="South Georgia and the South Sandwich">
                           South Georgia and the South Sandwich
                                    </asp:ListItem>
                                    <asp:ListItem Value="South Korea">
                           South Korea
                                    </asp:ListItem>
                                    <asp:ListItem Value="Spain">
                           Spain
                                    </asp:ListItem>
                                    <asp:ListItem Value="Spratly Islands">
                           Spratly Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sri Lanka">
                           Sri Lanka
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sudan">
                           Sudan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Surinam">
                           Surinam
                                    </asp:ListItem>
                                    <asp:ListItem Value="Svalbard">
                           Svalbard
                                    </asp:ListItem>
                                    <asp:ListItem Value="Swaziland">
                           Swaziland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Sweden">
                           Sweden
                                    </asp:ListItem>
                                    <asp:ListItem Value="Switzerland">
                           Switzerland
                                    </asp:ListItem>
                                    <asp:ListItem Value="Syria">
                           Syria
                                    </asp:ListItem>
                                    <asp:ListItem Value="Taiwan">
                           Taiwan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tajikistan">
                           Tajikistan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tanzania">
                           Tanzania
                                    </asp:ListItem>
                                    <asp:ListItem Value="Thailand">
                           Thailand
                                    </asp:ListItem>
                                    <asp:ListItem Value="Togo">
                           Togo
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tokelau">
                           Tokelau
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tonga">
                           Tonga
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tongareva">
                           Tongareva
                                    </asp:ListItem>
                                    <asp:ListItem Value="Trinidad and Tobago">
                           Trinidad and Tobago
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tromelin Island">
                           Tromelin Island
                                    </asp:ListItem>
                                    <asp:ListItem Value="Trust Territory of the Pacific Islands">
                           Trust Territory of the Pacific Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tuamotu Archipelago">
                           Tuamotu Archipelago
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tunisia">
                           Tunisia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Turkey">
                           Turkey
                                    </asp:ListItem>
                                    <asp:ListItem Value="Turkmenistan">
                           Turkmenistan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Turks and Calcos Islands">
                           Turks and Calcos Islands
                                    </asp:ListItem>
                                    <asp:ListItem Value="Tuvalu">
                           Tuvalu
                                    </asp:ListItem>
                                    <asp:ListItem Value="Uganda">
                           Uganda
                                    </asp:ListItem>
                                    <asp:ListItem Value="Ukraine">
                           Ukraine
                                    </asp:ListItem>
                                    <asp:ListItem Value="United Arab Emirates">
                           United Arab Emirates
                                    </asp:ListItem>
                                    <asp:ListItem Value="Unknown">
                           Unknown
                                    </asp:ListItem>
                                    <asp:ListItem Value="Uruguay">
                           Uruguay
                                    </asp:ListItem>
                                    <asp:ListItem Value="Uzbekistan">
                           Uzbekistan
                                    </asp:ListItem>
                                    <asp:ListItem Value="Vanuatu">
                           Vanuatu
                                    </asp:ListItem>
                                    <asp:ListItem Value="Vatican City">
                           Vatican City
                                    </asp:ListItem>
                                    <asp:ListItem Value="Venezuela">
                           Venezuela
                                    </asp:ListItem>
                                    <asp:ListItem Value="Vietnam">
                           Vietnam
                                    </asp:ListItem>
                                    <asp:ListItem Value="Wales">
                           Wales
                                    </asp:ListItem>
                                    <asp:ListItem Value="Wallis and Futuna">
                           Wallis and Futuna
                                    </asp:ListItem>
                                    <asp:ListItem Value="West Bank">
                           West Bank
                                    </asp:ListItem>
                                    <asp:ListItem Value="West Indies">
                           West Indies
                                    </asp:ListItem>
                                    <asp:ListItem Value="Western Samoa">
                           Western Samoa
                                    </asp:ListItem>
                                    <asp:ListItem Value="Yemen Arab Republic">
                           Yemen Arab Republic
                                    </asp:ListItem>
                                    <asp:ListItem Value="Zaire">
                           Zaire
                                    </asp:ListItem>
                                    <asp:ListItem Value="Zambia">
                           Zambia
                                    </asp:ListItem>
                                    <asp:ListItem Value="Zimbabwe">
                           Zimbabwe
                                    </asp:ListItem>
                                </asp:DropDownList></td>
                        </tr>
                    </table>
                    <table style="width: 100%;  text-align:left;" >
                        <tr>
                            <td style="width: 190px">
                                <sup><span style="color: #ff0000;">*</span></sup>Internet Location:</td>
                            <td>
                                <asp:DropDownList ID="ddlIncidentInformationInternetLocation" runat="server" Style="width: 361px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="Chat_IRC">Chat Room/IRC</asp:ListItem>
                                    <asp:ListItem Value="Email">E-mail</asp:ListItem>
                                    <asp:ListItem Value="FTP">FTP</asp:ListItem>
                                    <asp:ListItem Value="IM/ICQ">IM/ICQ</asp:ListItem>
                                    <asp:ListItem Value="News_Group">News Group</asp:ListItem>
                                    <asp:ListItem Value="Unknown">Unknown</asp:ListItem>
                                    <asp:ListItem Value="Web_Address">Web Address (URL)</asp:ListItem>
                                    <asp:ListItem Value="Peer_to_Peer">Peer to Peer</asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator13" runat="server" ControlToValidate="ddlIncidentInformationInternetLocation"
                                    Display="Dynamic" ErrorMessage="<b>Internet Location</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator></td>
                        </tr>
                        <tr>
                            <td>
                                Website/HTTP/URL/FTP:</td>
                            <td>
                                <asp:TextBox ID="txtSiteURL" runat="server" Style="width: 355px" MaxLength="500" /></td>
                        </tr>
                        <tr>
                            <td>
                                Chatroom:</td>
                            <td>
                                <asp:TextBox ID="txtChatroom" runat="server" Style="width: 355px" MaxLength="100" /></td>
                        </tr>
                        <tr>
                            <td>
                                IRC Channel Name:</td>
                            <td>
                                <asp:TextBox ID="txtIRCChannelName" runat="server" Style="width: 355px" MaxLength="100" /></td>
                        </tr>
                        <tr>
                            <td>
                                IRC Server Name:</td>
                            <td>
                                <asp:TextBox ID="txtIRCServerName" runat="server" Style="width: 355px" MaxLength="100" /></td>
                        </tr>
                        <tr>
                            <td>
                                Fserve Trigger:</td>
                            <td>
                                <asp:TextBox ID="txtFServeTrigger" runat="server" Style="width: 355px" MaxLength="200" /></td>
                        </tr>
                        <tr>
                            <td>
                                HTTP/FTP Login:</td>
                            <td>
                                <asp:TextBox ID="txtFTPLogin" runat="server" Style="width: 355px" MaxLength="100" /></td>
                        </tr>
                        <tr>
                            <td>
                                HTTP/FTP Password:</td>
                            <td>
                                <asp:TextBox ID="txtFTPPassword" runat="server" Style="width: 355px" MaxLength="100" /></td>
                        </tr>
                        <tr>
                            <td>
                                E-Mail Newsgroup Header:</td>
                            <td>
                                <asp:TextBox ID="txtEmailNewsgroupHeader" runat="server" Style="width: 355px" MaxLength="100" /></td>
                        </tr>
                    </table>
                    <br />
                    <h2>
                        Law Enforcement Information</h2>
                    <table style="width: 100%; text-align:left;">
                        <tr>
                            <td style="width: 270px">
                                <sup><span style="color: #ff0000;">*</span></sup>Has this been reported to NCMEC?</td>
                            <td>
                                <asp:DropDownList ID="ddlIncidentLocationReportedNCMEC" runat="server" Style="width: 61px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="No">No</asp:ListItem>
                                    <asp:ListItem Value="Yes">Yes</asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator17" runat="server" ControlToValidate="ddlIncidentLocationReportedNCMEC"
                                    Display="Dynamic" ErrorMessage="<b>NCMEC Reporting</b> is required." Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator></td>
                        </tr>
                        <tr>
                            <td style="width: 270px">
                                <sup><span style="color: #ff0000;">*</span></sup>Has this been reported to law enforcement?</td>
                            <td>
                                <asp:DropDownList ID="ddlIncidentLocationReportedLawEnforcement" runat="server" Style="width: 61px">
                                    <asp:ListItem Value=""></asp:ListItem>
                                    <asp:ListItem Value="No">No</asp:ListItem>
                                    <asp:ListItem Value="Yes">Yes</asp:ListItem>
                                </asp:DropDownList>
                                <asp:RequiredFieldValidator ID="RequiredFieldValidator18" runat="server" ControlToValidate="ddlIncidentLocationReportedLawEnforcement"
                                    Display="Dynamic" ErrorMessage="<b>Law Enforcement Reporting field</b> is required."
                                    Text="<img src='../Images/error-icon_small.gif'/>"></asp:RequiredFieldValidator></td>
                        </tr>
                        <tr>
                            <td style="width: 270px">
                                Officer&#39;s Name:</td>
                            <td>
                                <asp:TextBox ID="txtOfficerName" runat="server" MaxLength="150" Style="width: 276px"></asp:TextBox></td>
                        </tr>
                        <tr>
                            <td style="width: 270px">
                                Officer&#39;s Telephone Number:</td>
                            <td>
                                <asp:TextBox ID="txtOfficerTelephone" runat="server" Style="width: 276px" MaxLength="20" /></td>
                        </tr>
                    </table>
                    <br />
                    <h2>
                        Additional Information</h2>
                    <table style="width: 100%;  text-align:left;">
                        <tr>
                            <td style="width: 142px" valign="top">
                                Additional Information:</td>
                            <td>
                                <asp:TextBox ID="txtAdditionalInformation" runat="server" Style="width: 408px; height: 150px"
                                    TextMode="MultiLine"></asp:TextBox>
                                <br />
                            </td>
                        </tr>
                    </table>
                    <table style="width: 100%; text-align: center;">
                        <tr>
                            <td class="style8" style="width: 150px">
                                <asp:Button ID="btnSubmit1" runat="server" Style="width: 150px" Text="Submit" /></td>
                            <td class="style1">
                                <asp:Button ID="btnReset" runat="server" Style="width: 150px" Text="Reset" ValidationGroup="99999" /></td>
                        </tr>
                    </table>
                </td>
                <td valign="top">
                    <asp:ValidationSummary ID="vldSummaryContact" runat="server" HeaderText="<img src='../Images/error-icon_big.gif' />"
                        DisplayMode="List" />
                </td>
            </tr>
        </table>
    </asp:Panel>
    <center>
    <asp:Panel ID="pnlThankyou" runat="server" Visible="false">
        Your submission has been successfully received.
        <br />
        <br />
        <center><a href="http://charter.com/security">Go Back</a></center>
    </asp:Panel>
    </center>
                    </div>                    
                </div>
                <!-- #################################  -->                
                <!-- center area ends -->
                <!-- #################################  -->                
                




                
                <!-- #################################  -->                
                <!-- Right Menu Ends -->
                <!-- #################################  -->                
                <div style="float: left; margin: 0 auto; width: 180px; padding-left: 15px;">                    
                                                 
                </div>
                <!-- #################################  -->                
                <!-- Right Menu Ends -->
                <!-- #################################  -->                
                

            </div>
        </div>
    </div>
    <div class="clear">
    </div>    
</asp:Content> 