The question:

Answer choices (Min: 2 Max: 6):

Your first name:

Your age:
--45678910111213141516Pretty oldVery old

Your city:

Your state or province:
----- UNITED STATES ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming---- CANADA ----AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest Territories & NunavutNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory---- OTHER ----(just type it after your first name)

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