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* 1. Name (first and last)

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* 2. How old are you?

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* 3. Where do you live?

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* 4. Which race/ethnicity best describes you? (Please choose only one.)

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* 5. I am...

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* 6. I identify as...

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* 7. I am...

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* 8. What is your approximate average household income?

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* 9. What type of mobile telephone do you PRIMARILY use?

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* 10. Please enter your primary email address.

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