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E-Mail

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Date Of Birth

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Height

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Are you a High School graduate

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Have you ever used, possessed, sold, or transported, any illegal drugs to include Marijuana?

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No

Have you used Marijuana witin the last 90 days?

Yes
No

Have you ever been or currently beign charged, arrested, cited, or held by any law enforcement to include juvenile violations, traffic, and domestic violence?

Yes
No