*FIRST NAME (UPPERCASE)
please enter a min of 3 uppercase letters A-Z, spaces, & () - ' and , are valid.
*LAST NAME (UPPERCASE)
please enter a min of 3 uppercase letters A-Z, spaces, & () - ' and , are valid.
*DATE (EX: JANUARY 13, 2013 - UPPERCASE)
Sorry, only uppercase letters A-Z, numbers 0-9, spaces, & () - ' and , are valid.
*CITY AND STATE (UPPERCASE)
please enter a min of 3 uppercase letters A-Z, spaces, & () - ' and , are valid.