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* 1. Name

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* 2. E-mail Address

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* 3. Your location:

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* 4. How would you define the area you live in?

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* 5. Phone number to reach you

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* 6. Your age (OPTIONAL)

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

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* 8. Which of the following best describes your ethnicity?

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