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Name:

Address:

City:  State:  ZIP:

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 Age:  Gender:   Male   Female

Annual Household Income: less than 20,000 20,000-29,999 30,000,39,999 40,000-49,999 mor than 50,000

Where would you like to travel: Dallas,Texas Kansas City, Missouri Maple Ridge, British Columbia Sandusky, Ohio Purcellville Virginia Banff, Alberta

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