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Name?
Age?
Race?
Ethnic Background?
Eye Color?
Hair Color?
Height?
Weight?
Birth Place?
Place you Live Now?
Marital Status?
Children?
Do You Drink? How Much?
Smoke cigg.? How Many Packs a Day?
Smoke Wacky Tabacky?
Ever Been Arrested?
Ever Been Sent to a Mental Hospital?
Any Surgeries?
Do You Exercise?
Do You enjoy Dancing when you are all alone?
Would you like to make this survey public?
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