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* 1. What is your name? (First and Last)

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* 2. Are you allergic to nuts?

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* 3. What kind of chocolate do you prefer? (You can check more than one)

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* 4. What kind of candy do you prefer? (You can check more than one)

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* 5. Which of the following types of things do you like? These are to give some ideas about your general likes and may be helpful to your Secret Cupid. (You can check more than one)

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* 6. Describe a few of your interests or hobbies.

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