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</td>
<td id="form-wrapper">
</html>{{Template:2011FR/{{#ifeq: {{{country|US}}}|US|Form-template-recurring|{{{form-template|Form-template-default}}}}}
| country = {{#ifeq: {{{country|US}}}|XX|US|{{{country}}}}}
| appeal = {{{appeal|Appeal-default}}}
| form-countryspecific = {{#ifeq: {{{country|US}}}|US|Form-countryspecific-recurring|{{{form-countryspecific|Form-countryspecific-control}}}}}
}}<html>
</td>
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