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About You
Q.1
Where do you live?
Cornholme
Portsmouth
Elsewhere in Todmorden
Other:
Q.2
Please give your street name and postcode
Address Line 1
Address Line 2
Postcode
Q.3
What is your age?
Under 16
16-25
25-40
41-55
56-70
70+
Q.4
Please let us know your employment status:
Working full-time
Working part-time
Unemployed (receiving benefit)
Retired
Full time parent/carer
Other:
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