Please provide the following contact information:

Please provide the following contact information:

First Name
Last Name
Middle Initial
School
Home Street Address
Address (cont.)
City
State/Province	choose one IL MO
Zip/Postal Code
Grade/Position	choose one Freshman Sophomore Junior Senior Graduate Teacher/Staff
Home Phone
E-mail
Tee-shirt size	Please Choose Size Small Medium Large Extra-Large
Returning to TASK	Yes

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