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1. What is your name? If you want to remain anonymous use a fake name. Your responses (or part of them) may be read on the podcast or published.   (Required.)

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2. What, if any, gender do you identify with? (Required.)

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3. Share any of your negative or traumatic experiences around religion.  

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4. Have your experiences affected how you view that specific religion or organized religion as a whole?

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5. Do you have any comments or suggestions to make the Mental Illness Happy Hour podcast better? (Required.)

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