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* 1. What's your first name?

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* 2. What's your last name?

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* 3. E-Mail Address

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* 4. Phone number to reach you

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* 5. City and state you live in

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* 6. What's your age?

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* 7. What is your height

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* 8. What is your household income level?

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* 9. Which of the following best describes your current relationship status?

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* 10. Do you have children?

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* 11. What is the highest level of education that you have completed?

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