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* 1. Contact Information (Required)

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* 2. In what zip code do you want scooters?

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* 3. Age (Optional)

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* 4. Gender (Optional)

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* 5. What message would you have for your city officials? Why do you want scooters? (Optional)

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* 6. How did you first hear about Lyft Scooters? (Optional)

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