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1. Age of Participant: ____________________________________

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2. Would you consider moving into the Autumn House (Required.)

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3. What age do yo feel people would consider moving into the Autumn House?

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4. Did you know that the Autumn House is a not-for-profit and does not receive any funding from the government?

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5. Should the government fund the Autumn House?

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6. Would you sell an asset or use savings to reside in the Autumn House?

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7. Do you feel the Autumn House board has fulfilled its responsibilities and contributed positively to the Autumn House?

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