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2. 
4. First Name
5. Last Name
7. Address*
9. City
10. States
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11. Zip Code
13. What is your age?
14. What is your ethnicity?
16. How should we invest? *

    Please share anything you would like us to know about the infrastructure [the basic physical and organizational structures and facilities (e.g. buildings, roads, power supplies) needed for the operation of society] in your community. 

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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

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