My survey
Please fill out my Survey
Please tell me your name:
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And your e-mail too:
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1) How old are you?
Under 18 years old
Between 19 and 24 years old
Between 25 and 34 years old
Between 35 and 44 years old
More than 45 years old
2) How often do you visit my page?
Every Day
Once per week
Once per month
Once per year
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