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2014
October
S
Social Media Survey
Social Media Survey
0%
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Name
Gender
Date of birth
Marital Status
Single
Married
In a relationship
Divorced
Widowed
Other
Number and age of children/siblings
Number
Age/s
Children
Siblings
Type of Accommodation
-- Select --
Flat
Detached
Semi-Detached
Terraced
Other
Number of Bedrooms
-- Select --
N/A
1
2
3
4
5
6+
Household members and their relationship with you.
(E.G - Dave, Brother)
(Leave blank if you live alone.)
Household member name
Relationship
1
2
3
4
5
Place of residence (Town/City)
How long have you lived there?
0 - 5 Years
6 - 10 Years
More than 10 years
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