* 1. Please provide the following information.

* 2. What is your gender?

* 3. What is your age?

* 4. We are interested in speaking with people of varying ethnic backgrounds. Which of the following best describes your ethnicity?

* 5. Do you have any food allergies, food sensitivities and or food intolerances? Such as any known allergy to milk, egg, fish, crustacean shellfish, tree nuts, wheat, peanuts, soybeans?

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