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* 1. First Name

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* 2. Last Name

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* 3. Street Address

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* 4. City

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* 5. State

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* 6. Zip Code

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* 7. Phone Number

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* 8. Email Address

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* 9. How old are you? (You must between 25-54 years old to participate in this program)

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* 10. Sex:

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* 11. Are you personally affected by lactose intolerance?

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* 12. Do you currently use lactose free and/or soy-type products?

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* 13. How many cups of lactose free milk do you consume per day?

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* 14. Are you interested in experiencing a new lactose free milk?

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* 15. How does lactose intolerance impact your daily food choices: breakfast, lunch and dinner?

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* 16. How many friends/co-workers would you say you communicate with regarding lactose intolerance or lactose free food options on a weekly basis?

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* 17. If you were introduced to a new product that decreases the symptoms of lactose intolerance and liked it, would you be willing to share it with others?

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* 18. How do you look for information about lactose intolerance? (please check all that apply)

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* 19. If you checked any of the above, please list the individual locations, such as "Health Magazine."

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* 20. Do you actively engage in lactose intolerant conversations on social media networks/tools such as a blog, Facebook page, newsletter, magazine etc. If so, please share it with us.

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* 21. If you checked "yes", please list the names/urls:

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