How to create questions in the form of Table

I would like to test people’ memory. I will first present people with a table (see below Table 1) that contains several values in the beginning of the whole survey. At the end of the survey, I will ask them to recall the values in the table presented before and type the values in the exactly same but empty table (see below Table 2). So the problem is how to create a question in the form of table where people can directly type in their answers.
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