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* 1. What is your name?

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* 2. When were you diagnosed with melanoma?

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* 3. When did you take Zelboraf?

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* 4. Please briefly describe your experience with Zelboraf.

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* 5. Where are you located? Please list city and state.

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* 6. How old are you?

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* 7. Are you available for a phone or in-person interview during the week of April 23rd? Please list your availability.

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* 8. Are you male or female?

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* 9. Please share your email address.

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* 10. What is your telephone number? Please list mobile number if available.

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