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* 1. First Name:

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* 2. Surname:

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* 3. Mobile:

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* 4. Email:

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* 5. Home address:

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* 6. Do you live in:

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* 7. How would you describe your diet? (Please tick)

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* 8. Do you eat: (Please tick)

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* 9. How old are you? (Please tick)

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* 10. To which gender do you most identify? (Please tick)

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* 11. What type of mobile phone do you own? (Please tick)

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