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* 1. Contact Information 

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* 2. In what zip code do you want bikes?

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* 3. What is your age? (optional)

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* 4. What gender do you best identify with? (Optional)

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* 5. Why do you want Lyft Bikes in your city? What message would you have for your city officials? (Optional)

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* 6. How did you first hear about Lyft Bikes? (Optional)

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