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Child information
First Name:
Last Name:
Gender: Boy  Girl
Age:
T-Shirt Size:
Birthday: / /
School:
Email:
Home Phone: ()
 
Why you should be Mav's "Kid of the Month":
Billing information
Full Name (as on card):
Card Type:
Expiration: /
Card Number:
CVC2: [ ? ]
 
Billing Address:
City:
State:
Zip:
Questions/comments: