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Full Name:

Beauty Bulletin Username:

City:

Email Address:

Contact Number: (Cell Phone Number)

Under 12

13- 15 years old

16 -20 years old

21-25 years old

26-30 years old

31-35 years old

36 - 40 years old

41+

Asian

Black

Coloured

Indian

White

Mixed

Not at all likely

Extremely likely