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* 1. County in which you live? You must live in the southern 15 counties to be eligible for the giveaways.

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* 2. First Name: 

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* 3. Last Name: 

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* 4. Email: 

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* 5. Number of Children ages 5 and under:

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* 6. Number of children ages 6-12

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* 7. I want my children counted and pledge to complete the census

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* 8. I have already completed the census

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