*1.First Name:(Required.)

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*3.Phone Number:(Required.)

*4.E-Mail Address:(Required.)

5.Mailing Address:

6.What is your 5-digit zipcode?

7.Date of birth:

8.I consent to receive phone calls, emails and/or text messages from both Central Florida Basketball Partners, LLC d/b/a Lakeland Magic and Nationwide Roofing at the contact information that I have submitted, including my wireless number if provided. I understand these communications may be generated using automated technology.

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