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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?

School?

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

Thanks for submitting!

Contact

4075 Linglestown Rd #176
Harrisburg, PA 17112

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