Coastal Focus LLC-Charleston
Please fill out this form to update your information if you would like to be considered for upcoming projects. If you know of anyone who may be interested in being added to our database, please send them the link to this survey.
What is your full name? *
First and Last Name
Email Address *
Phone Number *
(555)555-5555
What is your gender? *
What is your ethnicity? *
What is your date of birth? *
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What is the city that you live in? *
What is the county that you live in? ex: Charleston, Dorchester, Berkeley, etc. *
What is the zip code? *
Highest level of education you have completed? *
What is your total annual household income BEFORE taxes? *
Includes everyone in your household
What do you currently do for a living? *
Job title (Retired/Student/Homemaker/ect)
What is your marital status? *
**Optional** What is your political identification?
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Do you have children under the age of 18 living at home? *
Are you a veteran of the United States Armed Forces? If so, which branch?
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