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Encuesta Online
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* Indicates required question
Apellidos:
*
Este campo debe ser ingresado en MAYÚSCULAS
Your answer
Nombres:
*
Este campo debe ser ingresado en MAYÚSCULAS
Your answer
Edad:
*
Your answer
Género
*
Hombre
Mujer
Etnia:
*
Blanco
Negro
Amarillo
Mestizo
Other:
Fumador:
*
Si
No
Deporte que practica
Futbol
Basket
Volley
Tenis de campo
Tenis de mesa
Atletismo
Other:
Alimentos que consume:
Frutas
Verduras
Carnicos
Lacteos
Grasas saturadas
Other:
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