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State Title For Which
You Are Competing:*
 
Contestant's Date of Birth:*   
       
Contestant's Age:  Automatically calculated from the Date of Birth (above)
 
Parent's Name:  
Contestant's First Name:  
Contestant's Last Name:  
Street Address:*  
Apartment / Suite:
City:*  
State:*  
Zip Code:*  
Daytime Phone:*  
Evening Phone:  
 
Email Address:*   (very important)
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