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Name

First Name

Last Name

Age

18-24

25-34

35-44

45-54

55-64

65+

Nearest City

Gender

Why are we asking? We sometimes want to create opportunities for women and non-binary people to share experiences specific to their gender.

Ethnicity

Why are we asking? We sometimes want to create opportunities for people of colour to share experiences specific to their ethnicity.

Anything else?

Terms and Conditions

I hereby acknowledge that I have read and understood the Privacy Policy and the terms and conditions upon which my personal data will be processed.*

*We can’t promise it’ll be a riveting read, but you can check out our Privacy Policy here.