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* 1. What is your FIRST and LAST name?

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* 2. What is the best phone number for us to contact you on?

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* 3. Email address:

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* 4. What is your gender?

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* 5. What is your age?

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* 6. Which of the following best describes your race or ethnicity?

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* 7. About how much is your total annual household income?

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* 8. Which of the following best describes your employment situation?

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* 9. What industry do you work in?

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* 10. What is your job title?

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