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2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
13. What would you like to include in the Time Capsule?*
15. Is this a photo or document?*

    1. Yes

    1. No
17. Please describe why this is of current or historical significance and worth including in the capsule.*
19. Please upload the file or document here. (If applicable.)
21. If this is a physical item, please describe its shape and size.
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field