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Soylent Innovation Circle Intake Form

1.Are you willing to participate in ongoing surveys, focus groups, and/ or feedback sessions?(Required.)
2.How did you hear about this opportunity?(Required.)
3.First Name(Required.)
4.Last Name(Required.)
5.Email Address Associated with your Soylent Account(Required.)
6.Age(Required.)
7.Birthdate (MM/DD/YYYY)(Required.)
8.What is the Soylent Product you use most often?(Required.)
9.Gender Identity(Required.)
10.Country of Residence(Required.)
11.What state do you reside in?(Required.)
12.Home Zip Code(Required.)
13.What is the highest level of education that you have completed?(Required.)
14.What is your relationship status?(Required.)
15.What is your current employment situation?(Required.)
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