Which age group do you fall into?
Under 18 18-24 25-34 35-44 45-54 55-64 65+
What is your gender?
Male Female Non-binary Prefer not to say
Which of the following best describes your employment status?
Employed full-time Employed part-time Self-employed Unemployed Student Retired Homemaker
How long have you lived in the local community?
Less than 1 year 1-5 years 6-10 years More than 10 years
All set, how can we reach you?
Name
Email
Phone
(Details here)
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