* 1. What is your full name?

* 2. What is your address?

* 3. What is your personal email address?

* 4. What is you phone number?

* 5. What county do you live in (eg: Suffolk, Norfolk, ect.)?

* 6. How old are you?

* 7. What is your gender?

* 8. Please describe your race/ethnicity.

* 9. What is you job/profession?

* 10. What, if any, was your college or graduate program area of study?

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