National Data Research is looking to invite women between the ages of 21 and 54 to participate in a study on Cigarettes.

This study would take place at our Downtown Chicago facility on Tuesday September 27th. The study will last 1 hour and you will be compensated with a $95 VISA gift card.

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* 1. First Name

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* 2. Last Name

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* 3. Contact Information

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* 4. Into which of the following age groups do you fall into?

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* 5. What is your specific age

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* 6. Gender

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