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Sussex County Movie Night
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14
Questions
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1
Name
*
This field is required.
Limit the number of guests to three, and all adults must register separately.
First Name
Last Name
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2
Phone Number
*
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Area Code
Phone Number
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3
Email
*
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example@example.com
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4
Income Range
*
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$0 - $9999
$10000 - $19999
$20000 - $29999
$30000 - $3999
$40000+
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5
Please select what best describes your race or family background:
*
This field is required.
African American
American Indian/Alaskan Native
Caucasian
Hispanic
Asian
Other
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6
Are you a Father
Yes
No
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7
What Zip Code Are You From
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8
Number of Children(s):
1
2
3
4
5
6
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9
Guest 1 Gender
Male
Female
Other
Type option 4
Other
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10
Guest 1 Age
0-6
7-10
11-13
14-16
17-18
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11
Guest 2 Gender
Male
Female
Other
Type option 4
Other
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12
Guest 2 Age
0-6
7-10
11-13
14-16
17-18
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13
Guest 3 Gender
Male
Female
Other
Type option 4
Other
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14
Guest 3 Age
0-6
7-10
11-13
14-16
17-18
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