* 1. Name

* 2. Email:

* 3. School:

* 4. Grade:

* 5. Home address:

* 6. City

* 7. State

* 8. Zipcode

* 9. Do you have any food allergies?

* 10. If you answered yes, please describe your food allergies.

* 11. What are your favorite subjects?

* 12. What technology would you most like to learn?

* 13. If you have done anything with technology before, please describe.

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