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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. What is your gender?
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4. What City and State do you currently reside in?
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5. What is your age?
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6. Which of the following best describes your ethnic background?
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7. Which of the following best describes your marital status?
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8. Which of the following best describes your employment situation?
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9. Into which of the following ranges does your annual household income fall?
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10. What industry do you work in?