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Name:
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Zip:
Household Income:
less than $30,000
$31,000 - $50,000
greater than $$51,000
Favorite Candy:
Gummies
Jelly Beans
Pops
Novelties
Powder Candy
Pressed Candy
Hard Candy
Bubble Gum
Mints
Other
What is Your Favorite Healthy Treat:
What Flavors Would You Like to See:
Where do You Buy Your Healthy Treats:
