Bold Fields are required First Name Last Name Phone Email Zip Code County → ADAMS ASHLAND ATHENS BELMONT BROWN CARROLL CLARK CLINTON COSHOCTON CUYAHOGA DEFIANCE ERIE FAYETTE FULTON GEAUGA GUERNSEY HANCOCK HARRISON HIGHLAND HOLMES JACKSON KNOX LAWRENCE LOGAN LUCAS MAHONING MEDINA MERCER MONROE MORGAN MUSKINGUM OTTAWA PERRY PIKE PREBLE RICHLAND SANDUSKY SENECA STARK TRUMBULL UNION VINTON WASHINGTON WILLIAMS WYANDOT Age → 0-64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Gender → Male Female Tobacco → No Yes Years on Part B:  ? → Less Than 3 More Than 3 Less Than 6 More Than 6 Comments?

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