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* 1. Please enter your first and last name.

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* 2. Please enter your cell or home phone so we can contact you if your name is drawn for a prize.

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* 3. What is the title of the book, magazine, eBook, or audio book you read/listened to?

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* 4. Who is the author of the book, eBook, or audio book you read/listened to? (If a magazine just input the title of magazine)

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* 5. Rate the book/magazine out of 5 stars.

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* 6. What was the best/worst part of the book/magazine? Did you like the characters? A specific article? Plot? Message? Was it informative?

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