COVID-19 Vaccine Interest

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* 1. Are you interested in the COVID-19 Vaccine?

Yes

No

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* 2. What is your Zip Code?

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* 3. What is your age range?

16-20

21-30

31-40

41-50

51-60

61-70

71-80

81-90

91-100

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* 4. What is your occupation?