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2016
November
H
Healthcare
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Name
*
Age
<2
2-10
11-20
21-30
31-40
40-50
>50
*
Gender
Male
Female
Other
Profession
*
City where you live in
-- Select --
Dhaka
Chittagong
Exact location
*
Marital status
Married
Unmarried
How many children do you have ?
*
Height
< 3
3-4 feet
4-5 feet
5-6 feet
>6
*
weight (in Kilograms)
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