Styled Mailchimp Form apply for lost citizenship electronic address first name last name telephone what do you dream of? where can we send you something address line 2 your city your region postal code country select country usa united kingdom elsewhere communications we would love to let you know about what is happening in our lost state: by email you may revoke your citizenship at any time we use mailchimp as our marketing platform. you acknowledge that your information will be transferred to them for processing. Learn more.