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| Optional |
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(MM/DD/YYYY) |
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| Gender: |
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| Are you a fan of the Clippers on Facebook?: |
Yes No I don't know |
| Do you follow @LAClippers on Twitter?: |
Yes No I don't know |
| Are there any other basketball fans in your household?: |
Yes, kids 12 and under
Yes, kids 13 – 18
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Yes, other adults No |
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| Address |
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| City: |
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| State/Province: |
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| Country/Region: |
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