Sandbox

sample survey

* Indicates required field

What is your most concerning issue? *

the economy health care the Constitution Other

If Other please specify: *

What is your age? *

Less than 13 13-18 19-25 26-35 36-50 Over 50 Prefer not to say

What is your household income? *

Less than $10,000 $10,001 - $25,000 $25,001 - $40,000 $40,001 - $70,000 $70,001 - $100,000 Greater than $100,000 Prefer not to say

Submit

* Indicates required field

Name *

First

Last

Email *

Comment *

Submit

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