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* 1. Full Name

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* 2. Email Address

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* 3. Are you a …

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* 4. What Age Range are you seeking?

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* 5. Marital Status

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* 6. Race (ethnicity)

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* 7. Do you smoke?

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* 8. Do you drink alcohol?

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* 9. What type of Relationship are you seeking?

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* 10. When dating someone, what distance are you willing to travel to see them on a
regular basis?

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