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2020-21 East Peoria Club Card
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First Name
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Your answer
Last Name
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Your answer
Address
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City
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Your answer
State
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Your answer
Zip Code
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Your answer
Your Email
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Your Cell #
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Birthdate
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MM
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DD
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YYYY
School
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East Peoria High School
Other
Graduation Year
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2021
2022
2023
2024
Male or Female
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Male
Female
Your Instagram
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Parent or Guardian Last Name (s) (who you live with)
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Your answer
Parent or Guardian First Name(s)
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Your answer
Parent Phone
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Parent Email
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