What is your first name?

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* 1. What is your first name?

What is your last name?

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* 2. What is your last name?

What is your age?

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* 3. What is your age?

What is your gender?

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* 4. What is your gender?

Which race/ethnicity best describes you? (Please choose only one.)

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* 5. Which race/ethnicity best describes you? (Please choose only one.)

If you identify with multiple ethnicities, please specify:

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* 6. If you identify with multiple ethnicities, please specify:

Street Address:

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* 7. Street Address:

City:

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* 8. City:

State:

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* 9. State:

Zip Code:

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* 10. Zip Code:

Email Address:

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* 11. Email Address:

Phone Number:

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* 12. Phone Number:

Place of Work:

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* 13. Place of Work:

What is your title?

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* 14. What is your title?

Please insert your LinkedIn profile URL:

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* 15. Please insert your LinkedIn profile URL:

How did you hear about Goodcity?

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* 17. How did you hear about Goodcity?

Was there a different way you heard about Goodcity? We would love to hear about it!

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* 18. Was there a different way you heard about Goodcity? We would love to hear about it!

Are you committed to making a difference in the city?

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* 19. Are you committed to making a difference in the city?

Do you want to subscribe to our newsletter?

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* 20. Do you want to subscribe to our newsletter?

Which of the following are you interested in?

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* 21. Which of the following are you interested in?

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