Here's the pic's origin: http://www.daylife.com/photo/01u33pL9Ns06D as well as this WaPo story: http://www.washingtonpost.com/wp-dyn/content/article/2007/01/24/AR2007012400371_pf.html This a translation of the text on the enrollment form: http://i519.photobucket.com/albums/u352/hrcbackup/AngkaTxt3.png