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Map Design, LLC
PO Box 42202
Des Moines, IA 50323

Please call with questions: (515)321-1570

Desired User Name:
E-mail Address:

I've reviewed the information my child has supplied and I've read the Privacy Policy and Terms(http://www.eatoutdesmoines.com/coppa.php?action=privacy) for this web site. I understand that profile information may be changed by a using a password. I understand that I may ask for this profile to be removed.

Parent/Guardian Full Name:
Relation to Child:
Telephone Number:
Email Address:
Signature:
Date: