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• First Name:

• Last Name:

• E-mail Address:

• Date of Birth:

  MM: Month 1 - Jan 2 - Feb 3 - March 4 - April 5 - May 6 - June 7 - July 8 - Augt 9 - Sept 10 - Oct 11 - Nov 12 - Dec DD: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YR: Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905

• Permanent Address:

• City:

• State/Province:

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• Zip Code/Postal Code:(No spaces or dashes)

• Phone Number:(Include area code)

• Gender:

  Male

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• Which of these theme weeks are you interested in:

  • Family Week
  • Best Friends Week
  • Sweetheart's Week
  • Armed Forces Week

• Are you a teacher?

  Yes

  No

• What grade level?

  Select a Grade Level 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

• Do you have a pet?

  Yes

  No

• What type of pet do you have?

  Select a Pet dog cat other

• Are you a parent with at least one child between the ages of 10-17 who might be interested in playing on a special version of Family Week?

  Yes

  No

• Are you a parent with a son/daughter who will be graduating from high school or college in the spring of 2010?

  Yes

  No

• What level of school?

  Select a Level High School College Graduate School

• Are you in the Armed Forces?

  Yes

  No

• If so, what branch of the Armed Forces?

  Select Your Military Branch Air Force Army Coast Guard Marine Corps National Guard Navy
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