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* 1. What is your name?

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* 2. In what ZIP code is your home located? (enter 5-digit ZIP code)

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* 3. What is your street address?

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* 4. What is your email address?

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* 5. Approximately how many times do you travel through the intersection of Rio Grande Blvd and Candelaria in a week?

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* 6. Are you in favor of the proposed roundabout or against it?

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* 7. Please provide any comments.

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