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Is this person currently disabled? *
Yes
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What is your occupation? *
-- Choose One --
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Arts/Entertainment
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Disabled
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What is your monthly income? *
-- Choose One --
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$1,001 - $2,000
$2,001 - $3,000
$3,001 - $4,000
$4,001 - $5,000
$5,001 - $6,000
$6,001 - $7,000
$7,001 - $8,000
$8,001 - $9,000
$9,001 - $10,000
Over $10,000
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Please select any health conditions that apply *
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Cancer
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