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"Are You Complacent?.wav" Eligibility Survey
Please make sure to answer truthfully to the questions below. Be aware that not all those who are eligible will be admitted into the program.
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What's your name, and best Email address for us to contact you?
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Your answer
Are you experiencing Digital Degradation?
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Yes
No
If so, how long have you been experiencing Digital Degradation?
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10 Years
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Have you attempted any home remedies to alleviate yourself of Digital Degradation?
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Yes
No
Why should we consider you to be a part of our test program?
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Your answer
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