Technology Giveaway Entry Form Has a child in your family participated in one of Modern Woodmen of America's Youth Educational Programs? If so, please enter now to win up to $10,000 of  equipment for your child's school or not-for-profit youth organization! One entry per day, per email address. For complete details, read the Technology Giveaway Rules. *First Name: *Last Name: *Birthdate:  mm/dd/yyyy *Phone:  555-555-5555 *Email address:  (example: member@hotmail.com)   Where did the Youth Educational Program take place? *School/organization name: *City: *State: Select a State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   *What is your association with the school/organization listed above? Teacher/youth leader who ordered program Parent of participating child Other adult family member of participating child   Are you a Modern Woodmen member? Yes No   Would you like a Modern Woodmen representative to contact you with additional information about the financial services, career opportunities and/or fraternal programs we offer? Yes No *Entrant home ZIP Code:   *Required Fields   To be eligible, entrants must have a direct associaton with Modern Woodmen of America's Youth Educational Programs. For the purpose of this contest, direct association is defined as the individual who orders the Modern Woodmen of America Youth Educational Program, a parent whose child participated in one of the Modern Woodmen of America Youth Educational Program, or another adult family member of a participating child.