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Register for device

Please complete the form to apply for a free computer

First Name/Nombre del Padre

Last Name/ Apellido del padre

Email Address

Phone

Phone Numero Celular

Select an Address/ Direccion

Do you have internet access at home?

Do you have a computer at home?

Annual Income

How many people live in your home?

Brief Explanation of how this device would help you and why you are interested in technology.

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Contact

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4075 Linglestown Rd #176

Harrisburg, PA 17112

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