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* 1. Name

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* 2. Email:

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* 3. School:

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* 4. Grade:

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* 5. Home address:

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* 6. City

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* 7. State

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* 8. Zipcode

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* 9. Do you have any food allergies?

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

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* 11. What are your favorite subjects?

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

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

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