* 1. What is your first name?

* 2. What is your last name?

* 3. What is your street address?

* 4. In what city do you live?

* 5. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

* 6. What school do you attend?

* 7. Grade:

* 8. Parent's Name

* 9. Address if different than address above

* 10. Email Address

* 11. Phone Number

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