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* 1. What is your name?

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* 2. What is your zip code?

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* 3. What is your age?

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* 4. What is your gender?

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* 5. Do you currently use an iPhone?

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* 6. What do you need Standwith for? (Ex: Cancer, surgery, aging parents, alzheimer's, etc)

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* 7. How are you hoping Standwith can help you?

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* 8. What is your email address?

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