The image you are looking at is known as a "captcha". In order to submit the form, you must enter
the text seen in the image into the text box. All letters are upper-case, and numbers only range
If you can't make out the text, click the refresh link seen below the image. Don't worry, this
does not reload the page, it will only change the image. This way you don't lose the info you have
already typed up.