What is your date of birth?
What is your gender?
On average, approximately how many hours per day did you spend outdoors during the 1950s and 1960s (when most fallout occurred)?
Did you consume mother's milk as an infant?
Have you been diagnosed with thyroid cancer?
For the time period from January 1951 through the end of 1982, specify where you lived as well as the type and amount of milk that you consumed. If your birthday is after January 1951, start with your birth month and year.
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