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* 1. How many people are in your household, including yourself, and what are the ages of each member?

  None Age: Under 5 Age: 5-10 Age: 11-18 Age: 19-29 Age: 30-45 Age: 46-64 Age: 65-74 Age: 75+
Household Family Member 1
Household Family Member 2
Household Family Member 3
Household Family Member 4
Household Family Member 5
Household Family Member 6

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* 2. What is your home zip code:

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* 3. Are you a WCPR pass holder?

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* 4. Have you signed up for a WCPR program or activity in the last 12 months?

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