* 1. What is your FIRST and LAST name?

* 2. What is the best phone number for us to contact you on?

* 3. What is your gender?

* 4. What City and State do you currently reside in?

* 5. What is your age?

* 6. Which of the following best describes your ethnic background?

* 7. Which of the following best describes your marital status?

* 8. Which of the following best describes your employment situation?

* 9. Into which of the following ranges does your annual household income fall?

* 10. What industry do you work in?

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