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First Name	Last Name	How did you hear about BRVC? Live In Area Work In Area Word of Mouth Newspaper Radio Search Engine, i.e. Good or Yahoo.com Local Advertising Attended an Event Drive By Billboard Other
Email	Mobile Number	Gender M F
Mailing Address		Birthday (Month/Day) 01 02 03 04 05 06 07 08 09 10 11 12  /  01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
City	State Zip	How many times in the last 3 months have you visited BRVC? Never Once or twice Three or four times Once or twice a month Every weekend Every week
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