Demographics

Where do you currently live?
(Address or cross streets and town):

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* 1. Where do you currently live?
(Address or cross streets and town):

What is your age group?

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* 2. What is your age group?

Are you? (Check all that apply)

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* 3. Are you? (Check all that apply)

Do you have access to an automobile that you can use on a daily basis?

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* 4. Do you have access to an automobile that you can use on a daily basis?

T