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Name:
   
 
 
 
Sex:
 
Male
 
Female
 
 
 
Age Group:
 
10-15
 
16-20
 
21-25
 
26-30
 
31-35
 
36-40
 
41-45
 
46-50
 
50-55
 
56-60
 
61-65
 
65+
 
 
 
What do you think this is?
   
 
 
 
Would you buy one?
 
Yes
 
No
 
Maybe
 
 
 
What do you like / dislike?
   
 
 
 
How much would you pay?
 
€0 - €9
 
€10 - €19
 
€20+
 
 
 
Comments/Suggestions:
   
 
 
 
Contact Details: