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Submission
 
Make a submission by filling out the form below.
 
General Information
 
* First Name: 
 
* Last Name: 
 
* Public Name: 
 
  This name will represent you publicly.
 
* Email: 
 
* Confirm Email: 
 
Phone: 
 
Address Line 1: 
 
Address Line 2: 
 
City: 
 
State: 
 
* Postal Code: 
 
Submission Information
 
*   
    By checking this box I agree to being the parent or legal guardian of child listed below (read full Publicity Release and Waiver).
 
* Submit Your Photo: 
 
  Please upload a JPEG file (.jpg or .jpeg)
 
* Child's First Name: 
 
* Child's Last Name: 
 
* Name of Team for child (if applicable): 
 
* Age of Child: 
 
* Sport or Activity: 
 
* Size of Tshirt desired if child wins: 
 
* City where child resides: 
 
  
    Opt IN : YES! I want to receive future communication and offers from WILX and their trusted partners
 
Confirm Age And Permission
 
* Description: 
 
Double check to make sure your entry is correct and then hit submit below.
By submitting the form you are confirming you are at least 18 years of age and have read and agree to our terms of service and privacy policy.
 
 
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