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Name
   
 
 
 
How long have you been at your current residence?
   
 
 
 
What is your date of birth?
 
 
 
What types of credit cards do you have (Select all that apply)?
 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club

 
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is your favorite hobby or interest?
 
Auto racing
 
Biking
 
Boating
 
Bowling
 
Camping
 
Crafts
 
Dancing
 
Fine Arts
 
Fishing
 
Gambling
 
Gardening
 
Hiking
 
Hunting
 
Horseback riding
 
Kayaking
 
Martial Arts
 
Music
 
Photography
 
Reading
 
Sports
 
Travel
 
Other
 
 
 
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How often do you conduct surveys?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
Other