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Questionaire

Please fill out this questionaire:

  • Full Name


  • Have you been convicted of crimes?
    Yes     No

  • Have you joined a terrorist organization?
    Yes     No

  • Have you taken any of these drugs illegally: marijuana, cocaine, heroin, ecstasy, methamphetamine?
    Yes     No

  • Do you have any heart disease?
    Yes     No

  • Do you have asthma?
    Yes     No

  • Do you carry HIV or other sex transmitted diseases?
    Yes     No

  • Are you overweight?
    Yes     No

I hereby declare that the information provided above is truthful.


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