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Basic Contact Information
First Name *
Last Name
Street Address
Street Address (Line 2)
City
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Zip/Postal Code *
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I would like to be eligible for prizes and to receive special offers from the sponsor of my coin.


Additional Demographic Information
4ACause.com is changing the world by getting good deeds done. We also want to recognize the groups who do good deeds. For example, we could report to the media about the coins started and the combined good deeds inspired by your group. Please answer the questions below. Your answers are important, as they will be the basis of a scientific understanding of good deeds.

Please indicate the groups you are affiliated with; list your strongest affiliation first.
Group 1:      
Group 2:      
Group 3:      
Group 4:      
Group 5:      

What is your favorite
professional sports team?
 
What year were you born?
Are you male or female?
Are you a pet owner?
What is the highest level of education you have completed?
What is your current marital status?
# of Children
Hours of Volunteer Work per Year
What is your race?
What is your total household income, including all earners in your household?

Please allow the sponsor of this coin to see this additional demographic data. I understand that my information will not be sold.

   

 
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